Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
Other names
NORTHEAST VALLEY HEALTH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY WYARD (CEO)
(818) 898-1388
Entity
Organization
Contact information
Practice address
1600 SAN FERNANDO RD, SAN FERNANDO, CA 91340-3115
(818) 365-5047
(818) 365-8095
Mailing address
1172 N MACLAY, SAN FERNANDO, CA 91340
(818) 898-1388
(818) 365-4031
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY17330
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2088136
PK
—
05
—
PHA17330
—
CA
05
—
PHY17330
—
CA
Enumeration date
01/08/2007
Last updated
07/19/2018
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