=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346114105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA BUENA VIDA PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2025
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51335 CESAR CHAVEZ ST STE 116
-----------------------------------------------------
City | COACHELLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92236-1528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-398-8866
-----------------------------------------------------
Fax | 760-398-9966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51335 CESAR CHAVEZ ST STE 116
-----------------------------------------------------
City | COACHELLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92236-1528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-398-8866
-----------------------------------------------------
Fax | 760-398-9966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | SIMONE YIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-398-8866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------