Provider Demographics
NPI:1942380282
Name:VALLEY DRUG COMPANY INC
Entity Type:Organization
Organization Name:VALLEY DRUG COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:ISSA
Authorized Official - Last Name:ELAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-355-8015
Mailing Address - Street 1:1302 SOMERVILLE RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4337
Mailing Address - Country:US
Mailing Address - Phone:256-355-8015
Mailing Address - Fax:256-355-7684
Practice Address - Street 1:1302 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4337
Practice Address - Country:US
Practice Address - Phone:256-355-8015
Practice Address - Fax:256-355-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL109900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001288Medicaid