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General NPI Number Information
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NPI Number | 1700095973
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Entity Type | Organization
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Legal Business Name | VALUE MEDICAL SOUTHEAST PHARMACY
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 105 KIOWA LANE
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City | PIEDMONT
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State | SC
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Zip | 29673
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Country | US
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Telephone | 800-861-4965
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Fax | 888-448-1725
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Provider Business Mailing Address
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Address Line | 105 KIOWA LANE
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City | PIEDMONT
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State | SC
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Zip | 29673
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Country | US
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Telephone | 800-861-4965
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Fax | 888-448-1725
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. ROBERT BRETT STEWART
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Credential |
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Telephone | 800-861-4965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50009230
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 08942
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 23857
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License Number State | AL
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