Organization
SPRING VALLEY LAKE PHARMACY INC
Active
Other names
A FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAAFAT FAYEZ ATTIA PHARMACIST (PRESIDENT/PIC)
(760) 244-3777
Entity
Organization
Contact information
Practice address
11919 HESPERIA RD, STE C, HESPERIA, CA 92345-2158
(760) 244-3777
(760) 242-8617
Mailing address
9778 SVL BOX, VICTORVILLE, CA 92395-5142
(760) 244-3777
(760) 244-2845
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY51251
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5614020
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/30/2006
Last updated
01/22/2014
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