Healthcare Provider Details

I. General information

NPI: 1700924180
Provider Name (Legal Business Name): VALLE VERDE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 GREEN VALLEY RD
FREEDOM CA
95019-3137
US

IV. Provider business mailing address

240 GREEN VALLEY RD
FREEDOM CA
95019-3137
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-2239
  • Fax: 831-728-9386
Mailing address:
  • Phone: 831-728-2239
  • Fax: 831-728-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY21728
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS F DEMBSKI JR.
Title or Position: PRESIDENT
Credential: PHARMD, RPH
Phone: 831-426-0200