Healthcare Provider Details

I. General information

NPI: 1003811134
Provider Name (Legal Business Name): PALMDALE MEDICAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/03/2024
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W. PALMDALE BLVD. #A
PALMDALE CA
93551-4232
US

IV. Provider business mailing address

540 W. PALMDALE BLVD. #A
PALMDALE CA
93551-4232
US

V. Phone/Fax

Practice location:
  • Phone: 661-267-2638
  • Fax: 661-267-0813
Mailing address:
  • Phone: 661-267-2638
  • Fax: 661-267-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: POOJAN VACHHANI
Title or Position: CEO/CFO/SEC./DIR.
Credential:
Phone: 661-267-2638