Healthcare Provider Details

I. General information

NPI: 1982973608
Provider Name (Legal Business Name): MARY KAY VALKUCHAK RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4517
US

IV. Provider business mailing address

1316 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4517
US

V. Phone/Fax

Practice location:
  • Phone: 757-548-4217
  • Fax: 757-548-4013
Mailing address:
  • Phone: 757-548-4217
  • Fax: 757-548-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202012202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: