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General NPI Number Information
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NPI Number | 1699122002
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Entity Type | Organization
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Legal Business Name | GREEN VALLEY PHARMACY LLC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 33733 YUCAIPA BLVD STE 1
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City | YUCAIPA
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State | CA
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Zip | 92399-2256
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Country | US
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Telephone | 909-980-0999
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Fax | 909-980-1099
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Provider Business Mailing Address
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Address Line | 8237 ROCHESTER AVE STE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0717
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Country | US
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Telephone | 909-980-0999
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Fax | 909-980-1099
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Authorized Official
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Title or Position | OWNER/CFO/AO
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Name | SYLVIA MOC
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Credential | CPA
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Telephone | 909-980-0999
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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 | 54475
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License Number State | CA
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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 |
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License Number State |
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