Provider Demographics
NPI:1689624157
Name:VALUE RX BLUEGRASS LLC
Entity Type:Organization
Organization Name:VALUE RX BLUEGRASS LLC
Other - Org Name:GUTHRIE'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:
Authorized Official - Phone:606-269-2965
Mailing Address - Street 1:520 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:IN
Mailing Address - Zip Code:47610-9712
Mailing Address - Country:US
Mailing Address - Phone:812-925-3347
Mailing Address - Fax:812-925-8931
Practice Address - Street 1:520 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:IN
Practice Address - Zip Code:47610-9712
Practice Address - Country:US
Practice Address - Phone:812-925-3347
Practice Address - Fax:812-925-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60002501A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175830OtherPK
IN300012994Medicaid