Healthcare Provider Details

I. General information

NPI: 1528169760
Provider Name (Legal Business Name): LILLIAM M VALLE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

Z1 AVE CARLOS JAVIER ANDALUZ URB. LOMAS VERDES
BAYAMON PR
00956-3467
US

IV. Provider business mailing address

PO BOX 11175
SAN JUAN PR
00922-1175
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-2458
  • Fax: 787-785-2458
Mailing address:
  • Phone: 787-785-2458
  • Fax: 787-785-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4010
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: