Provider Demographics
NPI:1124005384
Name:VALLEY PRESCRIPTION SERVICES, INC.
Entity Type:Organization
Organization Name:VALLEY PRESCRIPTION SERVICES, INC.
Other - Org Name:NORTH OAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARLEA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEATHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:816-453-1050
Mailing Address - Street 1:PO BOX 28444
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64188-8444
Mailing Address - Country:US
Mailing Address - Phone:816-453-9450
Mailing Address - Fax:816-878-6500
Practice Address - Street 1:4227 N. OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4541
Practice Address - Country:US
Practice Address - Phone:816-453-1050
Practice Address - Fax:816-453-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO0053863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0146470001Medicare ID - Type Unspecified