Healthcare Provider Details

I. General information

NPI: 1730351297
Provider Name (Legal Business Name): STEPHEN VALENTINE RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 638
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 638
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5170
  • Fax: 585-292-1701
Mailing address:
  • Phone: 585-275-5170
  • Fax: 585-292-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number043090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: