Healthcare Provider Details

I. General information

NPI: 1669731576
Provider Name (Legal Business Name): JV PHARMACY & MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 E LOS ANGELES AVE STE C
SIMI VALLEY CA
93065-2805
US

IV. Provider business mailing address

1357 E LOS ANGELES AVE STE C
SIMI VALLEY CA
93065-2805
US

V. Phone/Fax

Practice location:
  • Phone: 805-582-7474
  • Fax:
Mailing address:
  • Phone: 805-582-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY54367
License Number StateCA

VIII. Authorized Official

Name: VANDANA PARNAMI
Title or Position: PRESIDENT
Credential:
Phone: 818-731-7276