Provider Demographics
NPI:1215913033
Name:CATHEY VALLEY PHARMACY, INC
Entity type:Organization
Organization Name:CATHEY VALLEY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-698-3737
Mailing Address - Street 1:6712 HIGHWAY 441 N
Mailing Address - Street 2:
Mailing Address - City:DILLARD
Mailing Address - State:GA
Mailing Address - Zip Code:30537-2203
Mailing Address - Country:US
Mailing Address - Phone:706-746-5335
Mailing Address - Fax:800-347-9865
Practice Address - Street 1:6712 HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:DILLARD
Practice Address - State:GA
Practice Address - Zip Code:30537-2203
Practice Address - Country:US
Practice Address - Phone:706-746-5335
Practice Address - Fax:800-347-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE003315333600000X
KYGA381333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0217321000Medicaid
GA00037716AMedicaid
NC7702080Medicaid
SCDE1064Medicaid
GA00037716BMedicaid
GA00037716AMedicaid