Healthcare Provider Details

I. General information

NPI: 1821128539
Provider Name (Legal Business Name): VALLEY DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W 3RD AVE
KETTLE FALLS WA
99141-0435
US

IV. Provider business mailing address

PO BOX 435
KETTLE FALLS WA
99141-0435
US

V. Phone/Fax

Practice location:
  • Phone: 509-738-2223
  • Fax: 509-738-2559
Mailing address:
  • Phone: 509-738-2223
  • Fax: 509-738-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF58956
License Number StateWA

VIII. Authorized Official

Name: KEVIN HERDA
Title or Position: OWNER
Credential:
Phone: 509-935-8611