Provider Demographics
NPI:1407168461
Name:VALLEY DRUG CO
Entity Type:Organization
Organization Name:VALLEY DRUG CO
Other - Org Name:LAKE SPOKANE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-935-8611
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0107
Mailing Address - Country:US
Mailing Address - Phone:509-935-8611
Mailing Address - Fax:509-935-6983
Practice Address - Street 1:5919 HIGHWAY 291 STE 5
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-9525
Practice Address - Country:US
Practice Address - Phone:509-935-8611
Practice Address - Fax:509-935-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601572043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4933734OtherNCPDP PROVIDER IDENTIFICATION NUMBER