Healthcare Provider Details

I. General information

NPI: 1164509949
Provider Name (Legal Business Name): GOOD VALUE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10233 W GREENFIELD AVE
WEST ALLIS WI
53214-3911
US

IV. Provider business mailing address

10233 W GREENFIELD AVE
WEST ALLIS WI
53214-3911
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-5750
  • Fax: 414-727-5770
Mailing address:
  • Phone: 414-727-5750
  • Fax: 414-727-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8268
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number8268
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number8268
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number8268
License Number StateWI

VIII. Authorized Official

Name: MR. RICHARD A. PEARSON
Title or Position: PRESIDENT
Credential:
Phone: 414-727-5750