NPIMap

Organization Active NPI

Imgrx SJ Valley, Inc.

Doing business as United Health Centers Pharmacy Mendota

  • Community/Retail Pharmacy
  • Mendota, CA
National Provider Identifier
1871695130
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY 54517 Issued in CA
Legal business name
IMGRX SJ VALLEY, INC.
Doing business as
United Health Centers Pharmacy Mendota
Practice address
121 Barboza St
Building 3
Mendota, CA 93640-1901
Phone
(559) 655-5000
Fax
(559) 655-9604
NPI assigned
Sep 5, 2006
Last updated
Sep 20, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
IMGRX SJ VALLEY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Michael Brown
Title
Vice President, Managed Services
Phone
(281) 749-4764

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PHY 54517 CA Primary

Addresses

Primary practice location

121 Barboza St
Building 3
Mendota, CA 93640-1901

Mailing address

Attn: CHC Retail Pharmacy Dept. 13651 Dublin CT
Stafford, TX 77477
Phone (281) 749-4000

Other identifiers 1

IdentifierTypeStateIssuer
PHA462340MedicaidCA

Other names 1

  • United Health Centers Pharmacy Mendota Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Imgrx SJ Valley Inc11 organizations share this tax ID, including this one
Part of
Imgrx SJ Valley Inc

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

121 Barboza St
Bldg 3
Mendota, CA 93640
Phone (559) 655-5000

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1871695130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ATTN: CHC RETAIL PHARMACY DEPT. 13651 DUBLIN CT",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "77477",
            "telephone_number": "281-749-4000",
            "fax_number": "614-652-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 BARBOZA ST",
            "address_2": "BUILDING 3",
            "city": "MENDOTA",
            "state": "CA",
            "postal_code": "936401901",
            "telephone_number": "559-655-5000",
            "fax_number": "559-655-9604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMGRX SJ VALLEY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMGRX SJ VALLEY, INC.",
        "enumeration_date": "2006-09-05",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT, MANAGED SERVICES",
        "authorized_official_telephone_number": "281-749-4764"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY 54517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA462340",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "United Health Centers Pharmacy Mendota",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "United Health Centers Pharmacy Mendota",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mendota, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.