Healthcare Provider Details

I. General information

NPI: 1902970304
Provider Name (Legal Business Name): DANVILLE VALUE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CASSIDY WAY # 3
DANVILLE KY
40422-8457
US

IV. Provider business mailing address

60 CASSIDY WAY # 3
DANVILLE KY
40422-8457
US

V. Phone/Fax

Practice location:
  • Phone: 859-936-1222
  • Fax: 859-936-2003
Mailing address:
  • Phone: 859-936-1222
  • Fax: 859-936-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP06861
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP06861
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06861
License Number StateKY

VIII. Authorized Official

Name: MR. RAYMOND KENNETH FLOAT
Title or Position: OWNER
Credential: RPH
Phone: 859-936-1222