Provider Demographics
NPI:1922197615
Name:PHARMACY VALUE INC
Entity Type:Organization
Organization Name:PHARMACY VALUE INC
Other - Org Name:PHARMACY VALUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/PHARM
Authorized Official - Prefix:
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUERO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-662-7949
Mailing Address - Street 1:7012 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4708
Mailing Address - Country:US
Mailing Address - Phone:201-662-7949
Mailing Address - Fax:201-662-9469
Practice Address - Street 1:7012 PARK AVE
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4708
Practice Address - Country:US
Practice Address - Phone:201-662-7949
Practice Address - Fax:201-662-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NJ28RS004045003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2058384OtherPK
NJ4390105Medicaid
2058384OtherPK