Provider Demographics
NPI:1528161890
Name:VALLEY HEAD DRUGS LLC
Entity type:Organization
Organization Name:VALLEY HEAD DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-635-6812
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:VALLEY HEAD
Mailing Address - State:AL
Mailing Address - Zip Code:35989-0133
Mailing Address - Country:US
Mailing Address - Phone:256-635-6812
Mailing Address - Fax:256-635-6832
Practice Address - Street 1:114 COMMERCE AVE.
Practice Address - Street 2:
Practice Address - City:VALLEY HEAD
Practice Address - State:AL
Practice Address - Zip Code:35989
Practice Address - Country:US
Practice Address - Phone:256-635-6812
Practice Address - Fax:256-635-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1070003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5777500001Medicare NSC