Green Valley Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GREEN VALLEY PHARMACY LLC

Practice address

33733 Yucaipa Blvd Ste 1
Yucaipa, CA 92399-2256

Phone

(909) 980-0999

Fax

(909) 980-1099

NPI assigned

May 17, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sylvia Moc, CPA

Title

Owner/Cfo/Ao

Phone

(909) 980-0999

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Green Valley Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wai Tai Wong, RPH, APH

  • Pharmacist
  • Rancho Cucamonga, CA
  • NPI 1063825271
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1699122002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8237 ROCHESTER AVE STE 120",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300717",
            "telephone_number": "909-980-0999",
            "fax_number": "909-980-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33733 YUCAIPA BLVD STE 1",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923992256",
            "telephone_number": "909-980-0999",
            "fax_number": "909-980-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN VALLEY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-17",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "MOC",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_title_or_position": "OWNER/CFO/AO",
        "authorized_official_telephone_number": "909-980-0999",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "54475",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699122002",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Valley Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Green Valley Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christy Lee Gorden, MD
• Valerie Gordillo
• Angela Gordon-Nichols
• Shaina Dawn Goss, AMFT
• Isabella Grace
• Hannah Griep
• Stacy Lee Grillo, LVN
• Angela Gross
• Guiding Hope Marriage and Family Therapy Counseling Corporation.
• Jacklynn Gutierrez

• Community/Retail Pharmacy in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.