Provider Demographics
NPI:1386050557
Name:VALLEY PHARMACY EXPRESS LLC
Entity type:Organization
Organization Name:VALLEY PHARMACY EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUSAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:209-745-2564
Mailing Address - Street 1:835 C ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2800
Mailing Address - Country:US
Mailing Address - Phone:209-745-2564
Mailing Address - Fax:209-745-2574
Practice Address - Street 1:835 C ST
Practice Address - Street 2:#180
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-2800
Practice Address - Country:US
Practice Address - Phone:209-745-2564
Practice Address - Fax:209-745-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy