Healthcare Provider Details

I. General information

NPI: 1114470341
Provider Name (Legal Business Name): VALDY TJONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S ELLSWORTH RD
MESA AZ
85208-2305
US

IV. Provider business mailing address

435 S ELLSWORTH RD
MESA AZ
85208-2305
US

V. Phone/Fax

Practice location:
  • Phone: 480-380-3868
  • Fax: 480-380-4777
Mailing address:
  • Phone: 480-380-3868
  • Fax: 480-380-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS025673
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: