Provider Demographics
NPI:1417336686
Name:VALLEY DISCOUNT PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:VALLEY DISCOUNT PHARMACY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANOZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBOLISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-286-5905
Mailing Address - Street 1:1854 GEIBERGER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6224
Mailing Address - Country:US
Mailing Address - Phone:910-630-6653
Mailing Address - Fax:
Practice Address - Street 1:317 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3429
Practice Address - Country:US
Practice Address - Phone:910-630-6653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC22109333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies