Provider Demographics
NPI:1871538298
Name:VALLEY PHARMACY CORP
Entity type:Organization
Organization Name:VALLEY PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTEL
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:712-225-6121
Mailing Address - Street 1:800 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1278
Mailing Address - Country:US
Mailing Address - Phone:712-225-6121
Mailing Address - Fax:712-225-3782
Practice Address - Street 1:800 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1278
Practice Address - Country:US
Practice Address - Phone:712-225-6121
Practice Address - Fax:712-225-3782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0173369Medicaid
IA5176740001Medicare ID - Type Unspecified