=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598274292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY TO VALLEY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1130 W OLIVE AVE
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-557-1395
-----------------------------------------------------
Fax | 818-557-1383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1130 W OLIVE AVE
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-2214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-557-1395
-----------------------------------------------------
Fax | 818-557-1383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. VAHE TER-ZAKARIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-557-1395
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 55789
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------