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General NPI Number Information
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NPI Number | 1588109565
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Entity Type | Organization
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Legal Business Name | VALUE RX BLUEGRASS
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 05/09/2017
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Provider Practice Location Address
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Address Line | 21 MINK LN
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City | PINEVILLE
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State | KY
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Zip | 40977-8765
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Country | US
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Telephone | 270-886-4466
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Fax |
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Provider Business Mailing Address
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Address Line | P.O BOX 4022
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City | HOPKINSVILLE
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State | KY
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Zip | 42241
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Country | US
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Telephone | 270-886-4466
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Fax |
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Authorized Official
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Title or Position | MEMEBER
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Name | MR. TODD WALTERS
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Credential | RPH
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Telephone | 606-269-2965
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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 | KY
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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 | P07815
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License Number State | KY
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