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General NPI Number Information
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NPI Number | 1184910531
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Entity Type | Organization
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Legal Business Name | VALUE RX BLUEGRASS LLC
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 211 BURLEY AVE
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City | HOPKINSVILLE
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State | KY
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Zip | 42240
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Country | US
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Telephone | 270-885-1220
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Fax | 270-885-5474
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Provider Business Mailing Address
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Address Line | PO BOX 4022
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City | HOPKINSVILLE
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State | KY
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Zip | 42241-4022
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Country | US
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Telephone | 270-885-1220
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Fax | 270-885-5474
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Authorized Official
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Title or Position | OWNER
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Name | MR. TODD WALTERS
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Credential | RPH
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Telephone | 270-885-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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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 | P07816
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License Number State | KY
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