Organization
PROFESSIONAL VILLAGE PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN CLARKE RICHARDS IV PHARM.D. (PRESIDENT)
(916) 483-3455
Entity
Organization
Contact information
Practice address
1701 PROFESSIONAL DR, SACRAMENTO, CA 95825-2104
(916) 483-3455
(916) 483-6745
Mailing address
1701 PROFESSIONAL DR, SACRAMENTO, CA 95825-2104
(916) 483-3455
(916) 483-6745
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHY46997
CA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0573077
NABP
CA
01
—
4394840001
MEDICARE PTAN
—
05
—
PHA469970
—
CA
Enumeration date
10/10/2006
Last updated
08/22/2014
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