Healthcare Provider Details

I. General information

NPI: 1396732244
Provider Name (Legal Business Name): VALLEY PROFESSIONAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 1ST N
REXBURG ID
83440-1616
US

IV. Provider business mailing address

234 E 1ST N
REXBURG ID
83440-1616
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-6534
  • Fax: 208-356-6390
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1772CP
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NEIL STODDARD
Title or Position: OWNER PHARMACIST
Credential:
Phone: 208-356-6534