Healthcare Provider Details

I. General information

NPI: 1104349554
Provider Name (Legal Business Name): VALLEY FALLS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BROADWAY ST
VALLEY FALLS KS
66088-1302
US

IV. Provider business mailing address

320 BROADWAY ST
VALLEY FALLS KS
66088-1302
US

V. Phone/Fax

Practice location:
  • Phone: 785-945-3711
  • Fax: 785-945-6156
Mailing address:
  • Phone: 785-945-3711
  • Fax: 785-945-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-103438
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number2-103438
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2-103438
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number2-103438
License Number StateKS

VIII. Authorized Official

Name: LANCE FREEMAN
Title or Position: OWNER
Credential:
Phone: 785-945-3711