Provider Demographics
NPI:1285035261
Name:VALLEY APOTHECARY
Entity Type:Organization
Organization Name:VALLEY APOTHECARY
Other - Org Name:VALLEY APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-359-2284
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:NE
Mailing Address - Zip Code:68064-0630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 E GARDINER ST
Practice Address - Street 2:SUITE A
Practice Address - City:VALLEY
Practice Address - State:NE
Practice Address - Zip Code:68064-9798
Practice Address - Country:US
Practice Address - Phone:402-359-2284
Practice Address - Fax:402-359-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24813336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055605OtherPK