Provider Demographics
NPI:1669344321
Name:COACHELLA VALLEY PHARMACY, INC
Entity type:Organization
Organization Name:COACHELLA VALLEY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PEACHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-223-7188
Mailing Address - Street 1:77932 COUNTRY CLUB DRIVE
Mailing Address - Street 2:SUITE 2-2
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211
Mailing Address - Country:US
Mailing Address - Phone:760-223-7188
Mailing Address - Fax:760-223-7187
Practice Address - Street 1:77932 COUNTRY CLUB DRIVE
Practice Address - Street 2:SUITE 2-2
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211
Practice Address - Country:US
Practice Address - Phone:760-223-7188
Practice Address - Fax:760-223-7187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy