MARE ISLAND PHARMACY (2902)    INSTITUTION (4)

Name Value
NAME MARE ISLAND PHARMACY
STATE CALIFORNIA
STREET ADDR. 1 201 WALNUT AVE.
CITY VALLEJO
ZIP 94592-1107
OFFICIAL VA NAME MARE ISLAND PHARMACY
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME VALLEJO VA CBOC PHARMACY
ST. ADDR. 1 (MAILING) 201 WALNUT AVE.
CITY (MAILING) VALLEJO
STATE (MAILING) CALIFORNIA
ZIP (MAILING) 94592-1107
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1780632901
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE PACIFIC
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1780632901