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General NPI Number Information
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NPI Number | 1700924180
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Entity Type | Organization
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Legal Business Name | VALLE VERDE PHARMACY, INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 240 GREEN VALLEY RD
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City | FREEDOM
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State | CA
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Zip | 95019-3137
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Country | US
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Telephone | 831-728-2239
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Fax | 831-728-9386
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Provider Business Mailing Address
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Address Line | 240 GREEN VALLEY RD
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City | FREEDOM
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State | CA
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Zip | 95019-3137
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Country | US
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Telephone | 831-728-2239
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Fax | 831-728-9386
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS F DEMBSKI JR.
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Credential | PHARMD, RPH
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Telephone | 831-426-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY21728
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License Number State | CA
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