Provider Demographics
NPI:1679655096
Name:VILLAGE PHARMACY OF VALDEZ
Entity Type:Organization
Organization Name:VILLAGE PHARMACY OF VALDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-835-3737
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686-0248
Mailing Address - Country:US
Mailing Address - Phone:907-835-3737
Mailing Address - Fax:907-835-5757
Practice Address - Street 1:PIONEER AND MEALS STS.
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686
Practice Address - Country:US
Practice Address - Phone:907-835-3737
Practice Address - Fax:907-835-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK02083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0201638OtherNCPDP NUMBER
AKPH0208Medicaid