Provider Demographics
NPI:1619285988
Name:COUNTRY VALUE PHARMACY LLC
Entity Type:Organization
Organization Name:COUNTRY VALUE PHARMACY LLC
Other - Org Name:COUNTRY VALUE PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFRANCOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-995-0355
Mailing Address - Street 1:6201 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3200
Mailing Address - Country:US
Mailing Address - Phone:561-995-0355
Mailing Address - Fax:561-995-0435
Practice Address - Street 1:6201 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3200
Practice Address - Country:US
Practice Address - Phone:561-995-0355
Practice Address - Fax:561-995-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH248403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5703245OtherNCPDP PROVIDER IDENTIFICATION NUMBER