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: 09/30/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12959 S PARKER RD
PARKER CO
80134-3447
US

IV. Provider business mailing address

12959 S PARKER RD
PARKER CO
80134-3447
US

V. Phone/Fax

Practice location:
  • Phone: 303-840-7683
  • Fax: 303-805-5300
Mailing address:
  • Phone: 303-840-7683
  • Fax: 303-805-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0021332
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: