Provider Demographics
NPI:1407869571
Name:LONDON VALU-RITE PHARMACY INC.
Entity Type:Organization
Organization Name:LONDON VALU-RITE PHARMACY INC.
Other - Org Name:SOUTH CREEK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-348-1800
Mailing Address - Street 1:1 S CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9472
Mailing Address - Country:US
Mailing Address - Phone:606-348-1800
Mailing Address - Fax:
Practice Address - Street 1:130 WALMART PLAZA DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-7943
Practice Address - Country:US
Practice Address - Phone:606-348-1800
Practice Address - Fax:606-348-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06279332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90012105Medicaid
KY54032289Medicaid
KY54032289Medicaid