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General NPI Number Information
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NPI Number | 1164509949
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Entity Type | Organization
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Legal Business Name | GOOD VALUE PHARMACY LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 10233 W GREENFIELD AVE
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City | WEST ALLIS
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State | WI
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Zip | 53214-3911
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Country | US
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Telephone | 414-727-5750
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Fax | 414-727-5770
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Provider Business Mailing Address
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Address Line | 10233 W GREENFIELD AVE
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City | WEST ALLIS
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State | WI
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Zip | 53214-3911
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Country | US
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Telephone | 414-727-5750
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Fax | 414-727-5770
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD A. PEARSON
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Credential |
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Telephone | 414-727-5750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 8268
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 8268
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 8268
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 8268
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License Number State | WI
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