Spring Valley Lake Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY51251 Issued in CA

Legal business name

SPRING VALLEY LAKE PHARMACY INC

Doing business as

A Family Pharmacy

Practice address

11919 Hesperia Rd
Ste C
Hesperia, CA 92345-2158

Phone

(760) 244-3777

Fax

(760) 242-8617

NPI assigned

Aug 30, 2006

Last updated

Jan 22, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Raafat Fayez Attia, PHARMACIST

Title

President/Pic

Phone

(760) 244-3777

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• A FAMILY PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390348800000",
    "number": "1750491577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9778 SVL BOX",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955142",
            "telephone_number": "760-244-3777",
            "fax_number": "760-244-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11919 HESPERIA RD",
            "address_2": "STE C",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923452158",
            "telephone_number": "760-244-3777",
            "fax_number": "760-242-8617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING VALLEY LAKE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2014-01-22",
        "status": "A",
        "authorized_official_last_name": "ATTIA",
        "authorized_official_first_name": "RAAFAT",
        "authorized_official_middle_name": "FAYEZ",
        "authorized_official_title_or_position": "PRESIDENT/PIC",
        "authorized_official_telephone_number": "760-244-3777",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY51251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5614020",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A FAMILY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Geovannie Sosa
• Alma Soto
• Daniel Isiah Soto
• Alphonso Lancelot Spears III
• Milbrycleyo Spicer
• Albert Lamont Springer
• Stevie Alicia St Onge
• St. Jude Neighborhood Health Centers
• St. Mary High Desert Home Health Services, LLC (Providence Home Health High Desert)
• Annabelle Mae Stelling

• Community/Retail Pharmacy in Hesperia, CA
• Providers in Hesperia, 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 Jan 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.