Provider Demographics
NPI:1164512802
Name:JAMESTOWN VALU-RITE PHARMACY INC
Entity Type:Organization
Organization Name:JAMESTOWN VALU-RITE PHARMACY INC
Other - Org Name:JAMESTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-343-4443
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42629-0499
Mailing Address - Country:US
Mailing Address - Phone:270-343-4443
Mailing Address - Fax:270-343-4481
Practice Address - Street 1:1417 N MAIN ST STE A
Practice Address - Street 2:STE A
Practice Address - City:JAMESTOWN
Practice Address - State:KY
Practice Address - Zip Code:42629-2411
Practice Address - Country:US
Practice Address - Phone:270-343-4443
Practice Address - Fax:270-343-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP005353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030203OtherPK
KY54006313Medicaid
0384240001Medicare NSC