Provider Demographics
NPI:1609867290
Name:VALUE RX BLUEGRASS LLC
Entity Type:Organization
Organization Name:VALUE RX BLUEGRASS LLC
Other - Org Name:CAYCE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-886-4466
Mailing Address - Street 1:1112 WEST 7TH ST
Mailing Address - Street 2:PO BOX 4022
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241
Mailing Address - Country:US
Mailing Address - Phone:270-886-4466
Mailing Address - Fax:270-886-8915
Practice Address - Street 1:1112 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1818
Practice Address - Country:US
Practice Address - Phone:270-886-4466
Practice Address - Fax:270-886-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP07815333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54017348Medicaid
KY90120247Medicaid
KY90120247Medicaid