Provider Demographics
NPI:1851843478
Name:VALUE PHARMACY LLC
Entity Type:Organization
Organization Name:VALUE PHARMACY LLC
Other - Org Name:VALUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-804-6880
Mailing Address - Street 1:PO BOX 50522
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-0522
Mailing Address - Country:US
Mailing Address - Phone:612-886-3480
Mailing Address - Fax:612-886-3471
Practice Address - Street 1:1839 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3745
Practice Address - Country:US
Practice Address - Phone:612-886-3480
Practice Address - Fax:612-886-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2651863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165909OtherPK
MN1851843478Medicaid