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Organization
VONS COMPANIES INC
Active
Organization
VONS COMPANIES INC
Active
Other names
VONS PHARMACY #1796
Organization subpart
No
Provider details
NPI number
Authorized official
DEMOND HAWKINS CPHT MBA (THIRD PARTY MANAGER)
(208) 395-3905
Entity
Organization
Contact information
Practice address
33644 YUCAIPA BLVD, YUCAIPA, CA 92399-2071
(909) 790-1961
(909) 797-9526
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC 2-B, BOISE, ID 83706-3940
(208) 395-6200
(623) 282-3834
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52295
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437195211
—
CA
01
—
2002300
PK
—
Enumeration date
06/21/2006
Last updated
07/19/2018
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