Healthcare Provider Details

I. General information

NPI: 1942211453
Provider Name (Legal Business Name): WASCO VALLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 7TH ST
WASCO CA
93280-1819
US

IV. Provider business mailing address

PO BOX 1257
WASCO CA
93280-8157
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-1123
  • Fax: 661-759-2800
Mailing address:
  • Phone: 661-758-1123
  • Fax: 661-759-2800

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 NumberPHY47090
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MORRIS LWENYA
Title or Position: PIC AND OWNER
Credential: RPH
Phone: 661-758-1123