Healthcare Provider Details

I. General information

NPI: 1679564298
Provider Name (Legal Business Name): VALERIE DENISE INGOLDSBY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 N WICKHAM RD
MELBOURNE FL
32935-8945
US

IV. Provider business mailing address

3615 AUDREY DR
TITUSVILLE FL
32796-2901
US

V. Phone/Fax

Practice location:
  • Phone: 321-254-5507
  • Fax: 321-254-5032
Mailing address:
  • Phone: 321-269-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0024012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: