Healthcare Provider Details

I. General information

NPI: 1700952306
Provider Name (Legal Business Name): PEACHLAND PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 11/06/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 PEACHLAND AVE #102
NEWHALL CA
91321
US

IV. Provider business mailing address

25050 PEACHLAND AVE #102
NEWHALL CA
91321
US

V. Phone/Fax

Practice location:
  • Phone: 661-225-7910
  • Fax: 661-255-6798
Mailing address:
  • Phone: 619-962-2043
  • Fax: 661-255-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY 48891
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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