Healthcare Provider Details

I. General information

NPI: 1174121412
Provider Name (Legal Business Name): JAMESTOWN VALU-RITE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 N MAIN ST
JAMESTOWN KY
42629-2411
US

IV. Provider business mailing address

PO BOX 499
JAMESTOWN KY
42629-0499
US

V. Phone/Fax

Practice location:
  • Phone: 270-343-4443
  • Fax: 270-343-4481
Mailing address:
  • Phone: 270-343-4443
  • Fax: 270-343-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY LOUIS WARNER
Title or Position: OWNER
Credential: RPH
Phone: 270-343-4444