Healthcare Provider Details

I. General information

NPI: 1356407621
Provider Name (Legal Business Name): VALLEY VIEW PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11141 STATE ROUTE 800 NE
MAGNOLIA OH
44643-8321
US

IV. Provider business mailing address

11141 STATE ROUTE 800 NE
MAGNOLIA OH
44643-8321
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-3380
  • Fax: 330-866-3343
Mailing address:
  • Phone: 330-866-3380
  • Fax: 330-866-3343

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 Number020459300
License Number StateOH

VIII. Authorized Official

Name: RONALD LIDDERDALE
Title or Position: OWNER
Credential:
Phone: 330-866-3380