Provider Demographics
NPI:1558584227
Name:HIGH DESERT HEALTH SYSTEM PHARMACY
Entity type:Organization
Organization Name:HIGH DESERT HEALTH SYSTEM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NADRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALADY BOUZIANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:661-945-8456
Mailing Address - Street 1:44900 60TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7618
Mailing Address - Country:US
Mailing Address - Phone:661-945-8455
Mailing Address - Fax:661-949-0448
Practice Address - Street 1:44900 60TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7618
Practice Address - Country:US
Practice Address - Phone:661-945-8455
Practice Address - Fax:661-949-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE464283336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy