Provider Demographics
NPI:1033536883
Name:VALLEY INFUSION LLC
Entity Type:Organization
Organization Name:VALLEY INFUSION LLC
Other - Org Name:VALLEY VITAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-569-3463
Mailing Address - Street 1:1115 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-4312
Mailing Address - Country:US
Mailing Address - Phone:540-569-3463
Mailing Address - Fax:888-801-3124
Practice Address - Street 1:1115 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4312
Practice Address - Country:US
Practice Address - Phone:540-569-3463
Practice Address - Fax:888-801-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010046013336C0003X
3336C0004X, 3336H0001X, 3336S0011X, 3336H0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033536883Medicaid
2145607OtherPK
2145607OtherPK