Provider Demographics
NPI:1164509949
Name:GOOD VALUE PHARMACY LLC
Entity Type:Organization
Organization Name:GOOD VALUE PHARMACY LLC
Other - Org Name:PRESCRIPTIONS PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-727-5750
Mailing Address - Street 1:10233 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3911
Mailing Address - Country:US
Mailing Address - Phone:414-727-5750
Mailing Address - Fax:414-727-5770
Practice Address - Street 1:10233 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3911
Practice Address - Country:US
Practice Address - Phone:414-727-5750
Practice Address - Fax:414-727-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8268333600000X, 3336I0012X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025290400Medicaid
WI33042600Medicaid
WI5116425OtherNCPDP NUMBER
IA0593400Medicaid
IA0593400Medicaid
IL=========001Medicaid
IL=========001Medicaid
5377150001Medicare NSC