Healthcare Provider Details

I. General information

NPI: 1194637843
Provider Name (Legal Business Name): VALLEY MEDICAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
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

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

V. Phone/Fax

Practice location:
  • Phone: 888-873-0126
  • Fax: 888-873-0126
Mailing address:
  • Phone: 888-873-0126
  • Fax: 888-873-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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