| Organization Name: | VALLE VERDE PHARMACY, INC |
| NPI Number: | 1528106994 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS F DEMBSKI (VICE PRESIDENT) |
| Mailing Address: | 240 Green Valley Rd Freedom |
| State: | CA US |
| Postal Code: | 950193137 |
| Phone Number: | 8317282239 |
| Fax Number: | 8317289386 |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | PHY21728 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |