Healthcare Provider Details

I. General information

NPI: 1407168461
Provider Name (Legal Business Name): VALLEY DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5919 HIGHWAY 291 STE 5
NINE MILE FALLS WA
99026-9525
US

IV. Provider business mailing address

PO BOX 107
CHEWELAH WA
99109-0107
US

V. Phone/Fax

Practice location:
  • Phone: 509-935-8611
  • Fax: 509-935-6983
Mailing address:
  • Phone: 509-935-8611
  • Fax: 509-935-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60157204
License Number StateWA

VIII. Authorized Official

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