Provider Demographics
NPI:1770573974
Name:VALU DISCOUNT, INC.
Entity type:Organization
Organization Name:VALU DISCOUNT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:P.I.C.
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-231-2424
Mailing Address - Street 1:7519 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1726
Mailing Address - Country:US
Mailing Address - Phone:502-231-2424
Mailing Address - Fax:502-231-8748
Practice Address - Street 1:7519 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1726
Practice Address - Country:US
Practice Address - Phone:502-231-2424
Practice Address - Fax:502-882-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54033170Medicaid