Provider Demographics
NPI:1235116765
Name:VALUE CARE PHARMACY INC
Entity Type:Organization
Organization Name:VALUE CARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HETLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-882-4809
Mailing Address - Street 1:122 E KEMP
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-3640
Mailing Address - Country:US
Mailing Address - Phone:605-882-4809
Mailing Address - Fax:605-882-5668
Practice Address - Street 1:122 E KEMP
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-3640
Practice Address - Country:US
Practice Address - Phone:605-882-4809
Practice Address - Fax:605-882-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1001832333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4304527OtherNCPDP
SD8500532Medicaid
SD8500532Medicaid