Provider Demographics
NPI:1326044645
Name:VALLEY PHARMACY, INC DBA FARMINGTON MEDICAL SUPPLIES AND SERVICES
Entity Type:Organization
Organization Name:VALLEY PHARMACY, INC DBA FARMINGTON MEDICAL SUPPLIES AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAVIOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-778-2520
Mailing Address - Street 1:407 WILTON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6125
Mailing Address - Country:US
Mailing Address - Phone:207-778-2520
Mailing Address - Fax:207-778-0313
Practice Address - Street 1:407 WILTON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6125
Practice Address - Country:US
Practice Address - Phone:207-778-2520
Practice Address - Fax:207-778-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0230189332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003238OtherANTHEM
ME003238OtherANTHEM