Healthcare Provider Details

I. General information

NPI: 1043312366
Provider Name (Legal Business Name): VIRGINIA VALDES PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 S.W 122 AVE # 1
MIAMI FL
33175
US

IV. Provider business mailing address

1201 N.W 16 STREET
MIAMI FL
33125
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-5380
  • Fax:
Mailing address:
  • Phone: 305-575-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2686
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: