Organization
IMGRX SJ VALLEY, INC.
Active
Parent organization
IMGRX SJ VALLEY, INC.
Other names
United Health Centers Pharmacy Mendota
Organization subpart
Yes
Provider details
NPI number
Legal business name
IMGRX SJ VALLEY, INC.
Authorized official
MICHAEL BROWN (VICE PRESIDENT, MANAGED SERVICES)
(281) 749-4764
Entity
Organization
Contact information
Practice address
121 BARBOZA ST, BUILDING 3, MENDOTA, CA 93640-1901
(559) 655-5000
(559) 655-9604
Mailing address
ATTN: CHC RETAIL PHARMACY DEPT. 13651 DUBLIN CT, STAFFORD, TX 77477
(281) 749-4000
(614) 652-0326
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY 54517
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA462340
—
CA
Enumeration date
09/05/2006
Last updated
09/20/2022
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