Provider Demographics
NPI:1588939284
Name:VALLEY COMPOUNDING PHARMACY LLC
Entity type:Organization
Organization Name:VALLEY COMPOUNDING PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-419-0928
Mailing Address - Street 1:221 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3802
Mailing Address - Country:US
Mailing Address - Phone:360-419-0928
Mailing Address - Fax:360-419-0929
Practice Address - Street 1:221 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3802
Practice Address - Country:US
Practice Address - Phone:360-419-0928
Practice Address - Fax:360-419-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.602744513336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy