Provider Demographics
NPI:1427032176
Name:VALLE VERDE PHARMACY, INC.
Entity type:Organization
Organization Name:VALLE VERDE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:831-728-2239
Mailing Address - Street 1:240 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3137
Mailing Address - Country:US
Mailing Address - Phone:831-728-2239
Mailing Address - Fax:831-728-9386
Practice Address - Street 1:240 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3137
Practice Address - Country:US
Practice Address - Phone:831-728-2239
Practice Address - Fax:831-728-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY21728333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY21728OtherPHARMACY LICENSE
0567644OtherNABP NUMBER
0567644OtherNABP NUMBER
CAPHY21728OtherPHARMACY LICENSE