1598183816 NPI number — VALLEY PHARMACY INC

Table of content: (NPI 1598183816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598183816 NPI number — VALLEY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598183816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 ELBERTA AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASHMERE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-888-6650
Provider Business Mailing Address Fax Number:
509-782-3262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 ELBERTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASHMERE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98815-1090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-6650
Provider Business Practice Location Address Fax Number:
509-782-3262
Provider Enumeration Date:
04/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HARRELL
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
SHANE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-888-6650

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  60468330 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2145249 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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