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General NPI Number Information
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NPI Number | 1588842959
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Entity Type | Organization
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Legal Business Name | VALLEY COMPOUNDING PHARMACY, P.C.
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 22776 TIMBERLAKE RD SUITE C
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City | LYNCHBURG
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State | VA
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Zip | 24502-7310
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Country | US
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Telephone | 434-237-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 LANGHORNE RD SUITE A
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City | LYNCHBURG
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State | VA
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Zip | 24501-1124
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Country | US
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Telephone | 434-237-3331
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES VINCENT ETTARE II
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Credential | PHARMD
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Telephone | 434-237-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 0201004203
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License Number State | VA
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