Valor Compounding Pharmacy, Inc

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PHY55419 Issued in CA

Legal business name

VALOR COMPOUNDING PHARMACY, INC

Doing business as

Valor Compounding Pharmacy
Wellspring Compounding Pharmacy

Practice address

2461 Shattuck Ave.
Berkeley, CA 94704

Phone

(510) 548-8777

Fax

(510) 548-0305

NPI assigned

Mar 27, 2007

Last updated

Sep 28, 2020By 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

Richard T. Niemi

Title

Ceo

Phone

(916) 622-0267

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 3

• Valor Compounding Pharmacy Doing business as
• Wellspring Compounding Pharmacy Doing business as
• Wellspring Compounding Pharmacy, Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elisabetta Caria-Zadeh, RPH

  • Pharmacist
  • Berkeley, CA
  • NPI 1730021734
  NPD (past)
• Adam Scott Kiser, PHARMD

  • Pharmacist
  • Berkeley, CA
  • NPI 1821961905
  NPD (past)
• Hoda Iraninezhad Walker, PHARMD

  • Pharmacist
  • Berkeley, CA
  • NPI 1235002106
  NPD (past)

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1881712701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2461 SHATTUCK AVE.",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94704",
            "telephone_number": "510-548-8777",
            "fax_number": "510-548-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2461 SHATTUCK AVE.",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94704",
            "telephone_number": "510-548-8777",
            "fax_number": "510-548-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALOR COMPOUNDING PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "NIEMI",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-622-0267"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CA",
            "license": "PHY55419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160470",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valor Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellspring Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellspring Compounding Pharmacy, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Wellspring Compounding Pharmacy, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Eti Andrew Valdez-Kaminsky, MFT
• Heather Valdez, LCSW
• Diana Ibarra Valencia
• Blanca Estella Valentine, RN, NP, CNS
• Andrew Joseph Valeriano-Rollins
• Peter Van Arsdale
• Pamela Van Der Poel
• Jamie Juliana Van Hoften, M.D.
• Jessica Van Kessel, RN
• Deanna Van Ligten, PSY.D.

• Compounding Pharmacy in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Compounding Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; 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.