Organization
VALOR COMPOUNDING PHARMACY, INC
Active
Other names
Wellspring Compounding Pharmacy, Valor Compounding Pharmacy, Wellspring Compounding Pharmacy, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD T. NIEMI (CEO)
(916) 622-0267
Entity
Organization
Contact information
Practice address
2461 SHATTUCK AVE., BERKELEY, CA 94704
(510) 548-8777
(510) 548-0305
Mailing address
2461 SHATTUCK AVE., BERKELEY, CA 94704
(510) 548-8777
(510) 548-0305
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY55419
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160470
PK
—
Enumeration date
03/27/2007
Last updated
09/28/2020
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