Healthcare Provider Details

I. General information

NPI: 1104148774
Provider Name (Legal Business Name): VALRIE ROWENA ANDERSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W KINGSBRIDGE RD
BRONX NY
10468-3961
US

IV. Provider business mailing address

100 W KINGSBRIDGE RD
BRONX NY
10468-3961
US

V. Phone/Fax

Practice location:
  • Phone: 718-410-1288
  • Fax: 718-410-1580
Mailing address:
  • Phone: 718-410-1288
  • Fax: 718-410-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036412-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: