Provider Demographics
NPI:1811060544
Name:TOLLEY VALERIE
Entity type:Organization
Organization Name:TOLLEY VALERIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-420-0064
Mailing Address - Street 1:625 S PEAR ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4836
Mailing Address - Country:US
Mailing Address - Phone:601-420-0064
Mailing Address - Fax:601-420-0223
Practice Address - Street 1:625 S PEAR ORCHARD RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4836
Practice Address - Country:US
Practice Address - Phone:601-420-0064
Practice Address - Fax:601-420-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 261QI0500X, 332BP3500X, 3336C0004X, 3336H0001X, 3336M0002X, 3336S0011X
MS05882332BP3500X, 3336H0001X
MS05864111332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02736571Medicaid
MS00440861Medicaid
AL009985455Medicaid
MS2521549OtherNABP NUMBER
TN4582223Medicaid
MS02736571Medicaid
MS02736571Medicaid
TN4582223Medicaid