Healthcare Provider Details

I. General information

NPI: 1467616508
Provider Name (Legal Business Name): MIDVALLEY RX PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 ROYAL AVE
SIMI VALLEY CA
93065-4700
US

IV. Provider business mailing address

2519 ROYAL AVE
SIMI VALLEY CA
93065-4700
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-4013
  • Fax: 805-527-3756
Mailing address:
  • Phone: 805-527-4013
  • Fax: 805-527-3756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY30776
License Number StateCA

VIII. Authorized Official

Name: MRS. LILA CURTIS
Title or Position: OWNER
Credential:
Phone: 805-527-4013