Provider Demographics
NPI:1609151877
Name:VALUE SPECIALTY PHARMACY LLC
Entity type:Organization
Organization Name:VALUE SPECIALTY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-283-2210
Mailing Address - Street 1:4200 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1737
Mailing Address - Country:US
Mailing Address - Phone:855-265-8008
Mailing Address - Fax:844-812-6227
Practice Address - Street 1:4200 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1737
Practice Address - Country:US
Practice Address - Phone:855-265-8008
Practice Address - Fax:844-812-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 291U00000X, 3336C0002X, 3336L0003X
KYPA1991333600000X
HIPMP11313336C0003X
VA02140014103336S0011X
NY0312683336S0011X
DEA9-00010903336S0011X
TN0000005673.3336S0011X
OHNRP022200300033336S0011X
MD300723336S0011X
WVMO05603463336S0011X
PAPP4821503336S0011X
NJ28RO000720003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026644790001Medicaid
2132442OtherPK
6664460001Medicare NSC