Provider Demographics
NPI:1528147626
Name:GOLETA VALLEY MEDICAL PHARMACY
Entity type:Organization
Organization Name:GOLETA VALLEY MEDICAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DE HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:805-967-5634
Mailing Address - Street 1:334 S PATTERSON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2400
Mailing Address - Country:US
Mailing Address - Phone:805-967-5634
Mailing Address - Fax:805-683-4355
Practice Address - Street 1:334 S PATTERSON AVE STE 110
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2400
Practice Address - Country:US
Practice Address - Phone:805-967-5634
Practice Address - Fax:805-683-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4550070001Medicare ID - Type Unspecified