Provider Demographics
NPI:1043295637
Name:LONDON VALU-RITE PHARMACY
Entity type:Organization
Organization Name:LONDON VALU-RITE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DRYDEN
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-864-7127
Mailing Address - Street 1:202 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1763
Mailing Address - Country:US
Mailing Address - Phone:606-864-7127
Mailing Address - Fax:
Practice Address - Street 1:202 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1763
Practice Address - Country:US
Practice Address - Phone:606-864-7127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54029723Medicaid
KY0842600001Medicare ID - Type Unspecified