Provider Demographics
NPI:1699590596
Name:GOLDEN VALLEY HEALTH CENTERS
Entity type:Organization
Organization Name:GOLDEN VALLEY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWFIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-385-5201
Mailing Address - Street 1:1114 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2203
Mailing Address - Country:US
Mailing Address - Phone:209-722-4842
Mailing Address - Fax:
Practice Address - Street 1:1114 6TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2203
Practice Address - Country:US
Practice Address - Phone:209-722-4842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy