Provider Demographics
NPI:1215262423
Name:WEST VALLEY PHARMACY
Entity type:Organization
Organization Name:WEST VALLEY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:UCHENDU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:480-310-0564
Mailing Address - Street 1:6320 W UNION HILLS DR
Mailing Address - Street 2:STE 1200 B
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1096
Mailing Address - Country:US
Mailing Address - Phone:623-561-0710
Mailing Address - Fax:623-566-5886
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:STE 1200 B
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1096
Practice Address - Country:US
Practice Address - Phone:623-561-0710
Practice Address - Fax:623-566-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AZY0052103336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122475OtherPK
AZ504636Medicaid