Marvich Enterprises, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MARVICH ENTERPRISES, LLC

Doing business as

Hidden Valley Pharmacy

Practice address

19851 Hartmann Road
Suite C
Hidden Valley Lake, CA 95467

Phone

(707) 987-3995

Fax

(707) 987-3120

NPI assigned

Apr 2, 2007

Last updated

Mar 27, 2013By 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

Michael Maravich, PHARM. D.

Title

Managing Member

Phone

(707) 900-1524

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Hidden Valley Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364342400000",
    "number": "1790806602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19851 HARTMANN ROAD",
            "address_2": "SUITE C",
            "city": "HIDDEN VALLEY LAKE",
            "state": "CA",
            "postal_code": "95467",
            "telephone_number": "707-987-3995",
            "fax_number": "707-987-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19851 HARTMANN ROAD",
            "address_2": "SUITE C",
            "city": "HIDDEN VALLEY LAKE",
            "state": "CA",
            "postal_code": "95467",
            "telephone_number": "707-987-3995",
            "fax_number": "707-987-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVICH ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2013-03-27",
        "status": "A",
        "authorized_official_last_name": "MARAVICH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "707-900-1524",
        "authorized_official_credential": "PHARM. D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY45680",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHCY LICENSE",
            "identifier": "PHY45680",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA456800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hidden Valley Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lake County Office of Education
• Lake Health Services, Inc. (Lake Pharmacy)
• Betty Lue Lieber, MS, PHD, MFT
• Maravich Enterprises (Hidden Valley Pharmacy)
• Melanie Martinez
• Laura Nichols, LM
• Sean Thomas Parker, PA-C
• Reunion Inc (Reunion Ministries)
• Theresa Schmitz, P.A.
• Seed and Soil Collective Inc.

• Community/Retail Pharmacy in Hidden Valley Lake, CA
• Providers in Hidden Valley Lake, 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 Mar 27, 2013; 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.