Organization
NORTHEAST VALLEY HEALTH CORPORATION
Active
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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