Provider Demographics
NPI:1700095973
Name:VALUE MEDICAL SOUTHEAST PHARMACY
Entity Type:Organization
Organization Name:VALUE MEDICAL SOUTHEAST PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-861-4965
Mailing Address - Street 1:105 KIOWA LANE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673
Mailing Address - Country:US
Mailing Address - Phone:800-861-4965
Mailing Address - Fax:888-448-1725
Practice Address - Street 1:105 KIOWA LANE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673
Practice Address - Country:US
Practice Address - Phone:800-861-4965
Practice Address - Fax:888-448-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500092303336C0003X
NC089423336M0002X
AL238573336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4224781OtherNCPDP #
SC57-009230OtherBOARD OF PHARMACY PERMIT
SC57-009230OtherBOARD OF PHARMACY PERMIT