Healthcare Provider Details

I. General information

NPI: 1912933797
Provider Name (Legal Business Name): VONS COMPANIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57590 29 PALMS HWY
YUCCA VALLEY CA
92284-2934
US

IV. Provider business mailing address

250 E PARKCENTER BLVD MAILSTOP SEC 2-B
BOISE ID
83706-3940
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-0651
  • Fax: 760-365-9078
Mailing address:
  • Phone: 208-395-6200
  • Fax: 623-282-3834

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 NumberPHY52151
License Number StateCA

VIII. Authorized Official

Name: TIFFANY ELIOPULOS
Title or Position: ASSISTANT MANAGER, ENROLLMENTS
Credential:
Phone: 208-395-3906