Mountain Valley Rx 05 INC
NPI #1043364490 in Jefferson City, Tennessee
Provider Information
- NPI Number
- 1043364490
- Entity Type
- Organization
- Organization Name
- Mountain Valley Rx 05 INC
- Primary Specialty
- Pharmacy - Community/Retail Pharmacy
- Enumeration Date
- Jan 23, 2007
- Last Updated
- Mar 30, 2010
Practice Location
- Address
- 153 E BROADWAY BLVD
- Address 2
- STE 103
- City
- Jefferson City
- State
- Tennessee
- ZIP Code
- 37760-2517
- Phone
- (865) 471-5111
Authorized Official
- Name
- BEAU KISABETH
- Title
- MANAGER
- Phone
- (865) 388-3211
Specialties & Taxonomy Codes
| Specialty |
|---|
| Durable Medical Equipment & Medical Supplies |
| Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy |
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