Healthcare Provider Details

I. General information

NPI: 1952852857
Provider Name (Legal Business Name): VALLEY MEDICAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 VENOY RD STE 900A
WAYNE MI
48184-1869
US

IV. Provider business mailing address

7107 N WAYNE RD STE A
WESTLAND MI
48185-2172
US

V. Phone/Fax

Practice location:
  • Phone: 888-873-0126
  • Fax: 734-729-6546
Mailing address:
  • Phone: 313-433-2390
  • Fax: 734-729-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301011002
License Number StateMI

VIII. Authorized Official

Name: JEFF A HEATH
Title or Position: MANAGER
Credential: RPH
Phone: 888-873-0126