Provider Demographics
NPI:1104366582
Name:VALLEY HEALTH SYSTEMS
Entity Type:Organization
Organization Name:VALLEY HEALTH SYSTEMS
Other - Org Name:VALLEY HEALTH WAYNE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUVOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-399-3338
Mailing Address - Street 1:5636 US ROUTE 60 STE 1B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2189
Mailing Address - Country:US
Mailing Address - Phone:304-399-3338
Mailing Address - Fax:
Practice Address - Street 1:42 MCGINNIS DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-9553
Practice Address - Country:US
Practice Address - Phone:304-399-3341
Practice Address - Fax:304-272-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
WVMP05524263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1104366582Medicaid