Provider Demographics
NPI:1235247602
Name:VALUE PHARMACY CORP
Entity Type:Organization
Organization Name:VALUE PHARMACY CORP
Other - Org Name:VALUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-405-2300
Mailing Address - Street 1:1629 S MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5301
Mailing Address - Country:US
Mailing Address - Phone:734-405-2300
Mailing Address - Fax:734-405-2306
Practice Address - Street 1:1629 S MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5301
Practice Address - Country:US
Practice Address - Phone:734-405-2300
Practice Address - Fax:734-405-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010085003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2367692OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI2367692Medicaid
2367692OtherNCPDP PROVIDER IDENTIFICATION NUMBER