Provider Demographics
NPI:1336277094
Name:TWIN VALLEY PHARMACY INC
Entity Type:Organization
Organization Name:TWIN VALLEY PHARMACY INC
Other - Org Name:TWIN VALLEY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-964-9467
Mailing Address - Street 1:1250 COLUMBIA AVE E
Mailing Address - Street 2:STE B-1
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5159
Mailing Address - Country:US
Mailing Address - Phone:269-964-9467
Mailing Address - Fax:269-964-2866
Practice Address - Street 1:1250 COLUMBIA AVE E
Practice Address - Street 2:STE B-1
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5159
Practice Address - Country:US
Practice Address - Phone:269-964-9467
Practice Address - Fax:269-964-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010027733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2039893OtherPK
MI2524671Medicaid