Provider Demographics
NPI:1508934308
Name:VALLEY VIEW PHARMACY INC
Entity Type:Organization
Organization Name:VALLEY VIEW PHARMACY INC
Other - Org Name:VALLEY VIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-366-2112
Mailing Address - Street 1:4910 VALLEY VIEW BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-2040
Mailing Address - Country:US
Mailing Address - Phone:540-366-2112
Mailing Address - Fax:540-366-7201
Practice Address - Street 1:4910 VALLEY VIEW BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2040
Practice Address - Country:US
Practice Address - Phone:540-366-2112
Practice Address - Fax:540-366-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010024953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008501432Medicaid
4822450OtherNCPDP PROVIDER IDENTIFICATION NUMBER