Healthcare Provider Details

I. General information

NPI: 1023109212
Provider Name (Legal Business Name): VALUE RX BLUEGRASS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 ANDERSON RD
CRESCENT SPRINGS KY
41017
US

IV. Provider business mailing address

2446 ANDERSON RD
CRESCENT SPRINGS KY
41017
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-1660
  • Fax: 859-344-4142
Mailing address:
  • Phone: 859-341-1660
  • Fax: 859-344-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP07830
License Number StateKY

VIII. Authorized Official

Name: MS. TODD WALTERS
Title or Position: OWNER
Credential: RPH
Phone: 606-269-2965