Provider Demographics
NPI:1659366730
Name:VALLEY DRUG CO. INC.
Entity Type:Organization
Organization Name:VALLEY DRUG CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ELAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-355-6225
Mailing Address - Street 1:1101 16TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3594
Mailing Address - Country:US
Mailing Address - Phone:256-355-6225
Mailing Address - Fax:256-355-6243
Practice Address - Street 1:1101 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3594
Practice Address - Country:US
Practice Address - Phone:256-355-6225
Practice Address - Fax:256-355-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL109885333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0122553Medicare UPIN