Provider Demographics
NPI:1578204392
Name:VALLEY HEALTH SYSTEMS, INC
Entity Type:Organization
Organization Name:VALLEY HEALTH SYSTEMS, INC
Other - Org Name:VALLEY HEALTH HARTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUVOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:304-399-3338
Mailing Address - Street 1:5636 US ROUTE 60 STE 1B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2189
Mailing Address - Country:US
Mailing Address - Phone:304-399-3338
Mailing Address - Fax:
Practice Address - Street 1:22 FLEMING DR
Practice Address - Street 2:
Practice Address - City:HARTS
Practice Address - State:WV
Practice Address - Zip Code:25524-9788
Practice Address - Country:US
Practice Address - Phone:304-781-5021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00000Medicaid