Healthcare Provider Details

I. General information

NPI: 1457581365
Provider Name (Legal Business Name): VALLEY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 N LITCHFIELD RD STE 120
GOODYEAR AZ
85395-7822
US

IV. Provider business mailing address

7744 PORT ARTHUR DR
CORONA CA
92880-3537
US

V. Phone/Fax

Practice location:
  • Phone: 623-505-6500
  • Fax: 623-505-6505
Mailing address:
  • Phone: 909-327-8467
  • Fax: 623-505-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY005172
License Number StateAZ

VIII. Authorized Official

Name: AMGAD GADALLA
Title or Position: OFFICE MANAGER
Credential:
Phone: 623-505-6500