Provider Demographics
NPI:1346329828
Name:VALLEY PHARMACY INC
Entity type:Organization
Organization Name:VALLEY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-782-2717
Mailing Address - Street 1:119 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815
Mailing Address - Country:US
Mailing Address - Phone:509-782-2717
Mailing Address - Fax:509-782-3262
Practice Address - Street 1:119 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815
Practice Address - Country:US
Practice Address - Phone:509-782-2717
Practice Address - Fax:509-782-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WACF000008953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6081103Medicaid
WA9039116Medicaid
WA1346329828Medicare NSC
WA6081103Medicaid