Provider Demographics
NPI:1962064337
Name:STAR VALLEY PHARMACY
Entity type:Organization
Organization Name:STAR VALLEY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-453-5568
Mailing Address - Street 1:299 COUNTY ROAD 752
Mailing Address - Street 2:
Mailing Address - City:RICEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37370-5351
Mailing Address - Country:US
Mailing Address - Phone:423-453-0623
Mailing Address - Fax:
Practice Address - Street 1:4 E WASHINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3674
Practice Address - Country:US
Practice Address - Phone:423-453-5568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy