Provider Demographics
NPI:1821171950
Name:VALLEY PHARMACIES INC
Entity Type:Organization
Organization Name:VALLEY PHARMACIES INC
Other - Org Name:GROTTOES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-249-4802
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:GROTTOES
Mailing Address - State:VA
Mailing Address - Zip Code:24441-0338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 AUGUSTA AVENUE
Practice Address - Street 2:
Practice Address - City:GROTTOES
Practice Address - State:VA
Practice Address - Zip Code:24441
Practice Address - Country:US
Practice Address - Phone:540-249-5881
Practice Address - Fax:540-249-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010019163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2103672OtherPK
VA8517622Medicaid
2103672OtherPK
4817497OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VA8513503Medicaid