MEDICARE: VALU DRUG INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00010594	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366443921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALU DRUG INC.

Provider Business Mailing Address
First Line	:	201 E PIONEER AVE
Second Line	:
City	:	MONTESANO
State	:	WA
Zip	:	98563-4514
Country	:	US
Telephone Number	:	360-249-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E PIONEER AVE
Second Line	:
City	:	MONTESANO
State	:	WA
Zip	:	98563-4514
Country	:	US
Telephone Number	:	360-249-4444
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. CHARLES MARK SAGEN
Credential	:	RPH.
Telephone Number	:	360-249-4444

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	08/22/2020

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