Healthcare Provider Details

I. General information

NPI: 1922401116
Provider Name (Legal Business Name): VAL VISTA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 S. VAL VISTA DR. STE 108
GILBERT AZ
85297-7327
US

IV. Provider business mailing address

3570 S. VAL VISTA DR. STE 108,
GILBERT AZ
85297-7327
US

V. Phone/Fax

Practice location:
  • Phone: 480-887-0244
  • Fax: 480-847-6868
Mailing address:
  • Phone: 480-887-0244
  • Fax: 480-847-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberY006086
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY006086
License Number StateAZ

VIII. Authorized Official

Name: DR. JUSTIN JOHN CLARK
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 480-887-0244