Provider Demographics
NPI:1013902188
Name:VALLEY DRUG CO. INC.
Entity Type:Organization
Organization Name:VALLEY DRUG CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOFAMMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
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:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL011106332B00000X
AL109900333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0111106Medicare UPIN
AL0561900001Medicare ID - Type Unspecified