Healthcare Provider Details

I. General information

NPI: 1073938114
Provider Name (Legal Business Name): PEACHLAND PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 PEACHLAND AVE STE 100
NEWHALL CA
91321-2523
US

IV. Provider business mailing address

8881 FLETCHER PKWY STE 103
LA MESA CA
91942-3130
US

V. Phone/Fax

Practice location:
  • Phone: 661-255-7910
  • Fax: 661-255-7987
Mailing address:
  • Phone: 858-560-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARAM K PENARANDA
Title or Position: CFO/OWNER
Credential:
Phone: 619-962-2043