Provider Demographics
NPI:1700907268
Name:GOOD HEALTH INC
Entity Type:Organization
Organization Name:GOOD HEALTH INC
Other - Org Name:VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-336-9658
Mailing Address - Street 1:221 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3802
Mailing Address - Country:US
Mailing Address - Phone:360-336-9658
Mailing Address - Fax:360-336-9659
Practice Address - Street 1:221 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3802
Practice Address - Country:US
Practice Address - Phone:360-336-9658
Practice Address - Fax:360-336-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
WAPHARCF000054403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6001895Medicaid
4917867OtherNCPDP PROVIDER IDENTIFICATION NUMBER