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General NPI Number Information
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NPI Number | 1356750087
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Entity Type | Organization
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Legal Business Name | VALLEYWIDE PHARMACY AND DME INC
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 680 PAREDES LINE RD SUITE B
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City | BROWNSVILLE
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State | TX
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Zip | 78521
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Country | US
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Telephone | 956-372-1405
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Fax |
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Provider Business Mailing Address
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Address Line | 680 PAREDES LINE RD SUITE B
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City | BROWNSVILLE
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State | TX
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Zip | 78521-2482
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Country | US
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Telephone | 956-372-1405
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ABAYOMI ANTHONY GEORGE
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Credential |
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Telephone | 956-423-1426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31880
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License Number State | TX
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