=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598794547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VONS COMPANIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 06/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 933 SWEETWATER RD
-----------------------------------------------------
City | SPRING VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91977-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-460-6336
-----------------------------------------------------
Fax | 619-460-0287
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5918 STONERIDGE MALL RD
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-467-2806
-----------------------------------------------------
Fax | 925-467-2802
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGED CARE SPECIALIST
-----------------------------------------------------
Name | RRITA CALARA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-467-2811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | PHY43016
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------