Organization
IMGRX SONOMA INC
Active
Parent organization
IMGRX SONOMA INC
Other names
Sonoma Valley Community Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
IMGRX SONOMA INC
Authorized official
MICHAEL BROWN (VICE PRESIDENT, MANAGED SERVICES)
(281) 749-4764
Entity
Organization
Contact information
Practice address
19270 SONOMA HWY, SUITE A, SONOMA, CA 95476
(512) 596-2930
(707) 939-6056
Mailing address
13651 DUBLIN CT, STAFFORD, TX 77477-4317
(281) 749-4000
(614) 652-0326
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY54507
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2163676
PK
—
Enumeration date
06/03/2016
Last updated
09/15/2022
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