Provider Demographics
NPI:1508362310
Name:VALUE PHARMACY LLC
Entity Type:Organization
Organization Name:VALUE PHARMACY LLC
Other - Org Name:VALUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-237-3933
Mailing Address - Street 1:1400 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3954
Mailing Address - Country:US
Mailing Address - Phone:901-237-3933
Mailing Address - Fax:615-825-0120
Practice Address - Street 1:1400 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3954
Practice Address - Country:US
Practice Address - Phone:615-768-5118
Practice Address - Fax:615-825-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00006118333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176691OtherPK
TN1508362310Medicaid