Organization
MARAVICH ENTERPRISES
Active
Other names
Hidden Valley Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MARAVICH PHARMD (MANAGING MEMBER)
(707) 987-3995
Entity
Organization
Contact information
Practice address
19851 HARTMANN RD, UNIT C, HIDDEN VALLEY LAKE, CA 95467-8307
(707) 987-3995
(707) 987-3120
Mailing address
19851 HARTMANN RD, UNIT C, HIDDEN VALLEY LAKE, CA 95467-8307
(707) 987-3995
(707) 987-3120
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51432
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143179
PK
—
05
—
3765640
—
CA
Enumeration date
11/27/2013
Last updated
08/04/2015
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