Provider Demographics
NPI:1699736181
Name:VALUE CENTER PHARMACY INC
Entity type:Organization
Organization Name:VALUE CENTER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROLANDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST R PH
Authorized Official - Phone:248-583-1854
Mailing Address - Street 1:1485 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1055
Mailing Address - Country:US
Mailing Address - Phone:248-583-1854
Mailing Address - Fax:248-583-1986
Practice Address - Street 1:1485 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1055
Practice Address - Country:US
Practice Address - Phone:248-583-1854
Practice Address - Fax:248-583-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301007931333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2366044Medicaid
2366044OtherNCPDP (NABP)
MI5275740001Medicare NSC