Healthcare Provider Details

I. General information

NPI: 1447238498
Provider Name (Legal Business Name): VALLEY VIEW DRUG CO. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13966 VALLEY VIEW AVE
LA MIRADA CA
90638-3503
US

IV. Provider business mailing address

13966 VALLEY VIEW AVE
LA MIRADA CA
90638-3503
US

V. Phone/Fax

Practice location:
  • Phone: 562-941-1208
  • Fax: 562-903-0105
Mailing address:
  • Phone: 562-941-1208
  • Fax: 562-903-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY9951
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID MICHAEL JENSEN
Title or Position: PHARMACIST OWNER
Credential: PHD
Phone: 562-941-1208