Organization
SCOTT VALLEY PHARMACY INC
Active
Other names
Scott Valley Drug
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL TODD (CEO)
(541) 941-4032
Entity
Organization
Contact information
Practice address
511 MAIN STREET, ETNA, CA 96027-0610
(530) 467-5335
(530) 467-5111
Mailing address
PO BOX 610, ETNA, CA 96027-0610
(530) 467-5335
(530) 467-5111
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY50463
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0554306
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA369010
—
CA
Enumeration date
10/17/2006
Last updated
12/14/2010
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