Provider Demographics
NPI:1619986098
Name:VALU-MED PHARMACY, LLC
Entity Type:Organization
Organization Name:VALU-MED PHARMACY, LLC
Other - Org Name:VALU-MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:405-741-1200
Mailing Address - Street 1:1212 S DOUGLAS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5246
Mailing Address - Country:US
Mailing Address - Phone:405-741-1200
Mailing Address - Fax:405-741-1224
Practice Address - Street 1:1212 S DOUGLAS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5246
Practice Address - Country:US
Practice Address - Phone:405-741-1200
Practice Address - Fax:405-741-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-36173336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3718446OtherNCPDP
OK100242000AMedicaid
OK100242000AMedicaid