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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