Provider Demographics
NPI:1821128539
Name:VALLEY DRUG CO
Entity Type:Organization
Organization Name:VALLEY DRUG CO
Other - Org Name:KETTLE FALLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-935-8611
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:KETTLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99141-0435
Mailing Address - Country:US
Mailing Address - Phone:509-738-2223
Mailing Address - Fax:509-738-2559
Practice Address - Street 1:280 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:KETTLE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99141-0435
Practice Address - Country:US
Practice Address - Phone:509-738-2223
Practice Address - Fax:509-738-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF589563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4914431OtherNCPDP
WA6092803Medicaid
WA0335450001Medicare NSC