Provider Demographics
NPI:1225580640
Name:VALUE RX SNEEDVILLE LLC
Entity Type:Organization
Organization Name:VALUE RX SNEEDVILLE LLC
Other - Org Name:VALUE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-269-2965
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-0155
Mailing Address - Country:US
Mailing Address - Phone:865-585-8555
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3648
Practice Address - Country:US
Practice Address - Phone:423-724-8130
Practice Address - Fax:423-724-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005886333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166022OtherPK