MEDICARE: SCOTT VALLEY PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY50463	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0554306	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1558442681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT VALLEY PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 610
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027-0610
Country	:	US
Telephone Number	:	530-467-5335
Fax Number	:	530-467-5111

Provider Business Practice Location Address
First Line	:	511 MAIN STREET
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027-0610
Country	:	US
Telephone Number	:	530-467-5335
Fax Number	:	530-467-5111

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL TODD
Credential	:
Telephone Number	:	541-941-4032

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	12/14/2010

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Directions to “SCOTT VALLEY PHARMACY INC ” Practice Location

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