Healthcare Provider Details

I. General information

NPI: 1437145299
Provider Name (Legal Business Name): WILLOW VALLEY PHARMACY, INC., DBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W BROADWAY ST
NEEDLES CA
92363-2704
US

IV. Provider business mailing address

1101 W BROADWAY ST
NEEDLES CA
92363-2704
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-2312
  • Fax: 760-326-4178
Mailing address:
  • Phone: 760-326-2312
  • Fax: 760-326-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY33276
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD B POCOCK
Title or Position: RESPONSIBLE PHARMACIST
Credential: PHARM.D.
Phone: 760-326-2312