Healthcare Provider Details

I. General information

NPI: 1225580640
Provider Name (Legal Business Name): VALUE RX SNEEDVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAIN ST
SNEEDVILLE TN
37869-3648
US

IV. Provider business mailing address

PO BOX 155
SNEEDVILLE TN
37869-0155
US

V. Phone/Fax

Practice location:
  • Phone: 423-724-8130
  • Fax: 423-724-8544
Mailing address:
  • Phone: 865-585-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0000005886
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD WALTERS
Title or Position: PHARMACIST/MEMBER
Credential:
Phone: 606-269-2965