MEDICARE: VALLEY PRESCRIPTION SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336L0003X	Long Term Care Pharmacy	006529	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2141788	OTHER		PK

General Provider Information

NPI Number	:	1265414452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PRESCRIPTION SERVICES, INC.

Provider Business Mailing Address
First Line	:	100 PASSAVANT WAY
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-1318
Country	:	US
Telephone Number	:	412-820-1010
Fax Number	:	412-820-9157

Provider Business Practice Location Address
First Line	:	7275 N OAK TRFY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-1852
Country	:	US
Telephone Number	:	816-453-9450
Fax Number	:	816-878-6500

Authorized Official
Title or Position	:	PDC PHARMACY ADMIN
Name	:	BILL WALDRON
Credential	:
Telephone Number	:	412-820-1010

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/20/2017

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