Healthcare Provider Details

I. General information

NPI: 1104258045
Provider Name (Legal Business Name): VALLEY RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 HAMBURG TPKE
WAYNE NJ
07470-8416
US

IV. Provider business mailing address

791 HAMBURG TPKE
WAYNE NJ
07470-8416
US

V. Phone/Fax

Practice location:
  • Phone: 973-832-7200
  • Fax: 973-832-7202
Mailing address:
  • Phone: 973-832-7200
  • Fax: 973-832-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00727500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0395153
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier2140461
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: RINKAL PATEL
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 973-970-8990