Provider Demographics
NPI:1962149674
Name:EMERALD VALLEY RX, LLC
Entity type:Organization
Organization Name:EMERALD VALLEY RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-359-3334
Mailing Address - Street 1:176 MELTON RD
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9453
Mailing Address - Country:US
Mailing Address - Phone:541-359-3334
Mailing Address - Fax:
Practice Address - Street 1:176 MELTON RD
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9453
Practice Address - Country:US
Practice Address - Phone:541-359-3334
Practice Address - Fax:833-384-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy