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General NPI Number Information
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NPI Number | 1619494937
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Entity Type | Organization
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Legal Business Name | VALLEY LAKE INC
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2245 N GREEN VALLEY PKWY
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City | HENDERSON
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State | NV
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Zip | 89014-5024
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Country | US
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Telephone | 702-565-3374
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Fax | 702-565-3377
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Provider Business Mailing Address
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Address Line | 2245 N GREEN VALLEY PKWY
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City | HENDERSON
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State | NV
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Zip | 89014-5024
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Country | US
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Telephone | 702-565-3374
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Fax | 702-565-3377
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Authorized Official
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Title or Position | PHARMACY MANAGER/CEO
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Name | MR. AKUWUDIKE JOHN ANOZIE
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Credential |
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Telephone | 702-565-3374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH03781
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License Number State | NV
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