Organization
MARVICH ENTERPRISES, LLC
Active
Organization
MARVICH ENTERPRISES, LLC
Active
Other names
Hidden Valley Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MARAVICH PHARM. D. (MANAGING MEMBER)
(707) 900-1524
Entity
Organization
Contact information
Practice address
19851 HARTMANN ROAD, SUITE C, HIDDEN VALLEY LAKE, CA 95467
(707) 987-3995
(707) 987-3120
Mailing address
19851 HARTMANN ROAD, SUITE C, HIDDEN VALLEY LAKE, CA 95467
(707) 987-3995
(707) 987-3120
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
PHY45680
CA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA456800
—
CA
01
—
PHY45680
STATE PHCY LICENSE
CA
Enumeration date
04/02/2007
Last updated
03/27/2013
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