Provider Demographics
NPI:1073986022
Name:VALUE RX III LLC
Entity Type:Organization
Organization Name:VALUE RX III LLC
Other - Org Name:VALUE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:423-839-1663
Mailing Address - Street 1:6161 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8603
Mailing Address - Country:US
Mailing Address - Phone:423-839-1663
Mailing Address - Fax:423-839-2097
Practice Address - Street 1:6161 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8603
Practice Address - Country:US
Practice Address - Phone:423-839-1663
Practice Address - Fax:423-839-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000056853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000005685OtherSTATE PHARMACY LISCENSE NUMBER
TN7561400001Medicare NSC