Provider Demographics
NPI:1023109212
Name:VALUE RX BLUEGRASS LLC
Entity type:Organization
Organization Name:VALUE RX BLUEGRASS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-269-2965
Mailing Address - Street 1:2446 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-341-1660
Mailing Address - Fax:859-344-4142
Practice Address - Street 1:2446 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-341-1660
Practice Address - Fax:859-344-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07830333600000X
KY1482333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100175440Medicaid
KY7100175400Medicaid
0312880001Medicare NSC
0312880001Medicare ID - Type Unspecified