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General NPI Number Information
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NPI Number | 1770833386
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Entity Type | Organization
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Legal Business Name | LA BUENA VIDA PHARMACY INC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 51-335 CESAR CHAVEZ ST SUITE 116
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City | COACHELLA
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State | CA
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Zip | 92236-1547
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Country | US
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Telephone | 760-398-8866
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Fax | 760-398-9966
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Provider Business Mailing Address
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Address Line | 51-335 CESAR CHAVEZ ST SUITE 116
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City | COACHELLA
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State | CA
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Zip | 92236-1547
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Country | US
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Telephone | 760-398-8866
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Fax | 760-398-9966
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | DR. SIMONE AOY YEE YIK
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Credential | PHARM D
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Telephone | 760-398-8866
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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 | PHY51158
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License Number State | CA
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