Provider Demographics
NPI:1790898062
Name:LONDON VALU-RITE PHARMACY INC.
Entity Type:Organization
Organization Name:LONDON VALU-RITE PHARMACY INC.
Other - Org Name:LONDON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DRYDEN
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-343-2336
Mailing Address - Street 1:202 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1763
Mailing Address - Country:US
Mailing Address - Phone:606-864-7127
Mailing Address - Fax:
Practice Address - Street 1:202 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1763
Practice Address - Country:US
Practice Address - Phone:606-864-7127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06068332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90150632Medicaid
KY54029723Medicaid
KY90150632Medicaid