=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275904567
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALQUIRIA PIERUCCI RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2015
-----------------------------------------------------
Last Update Date | 08/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 STAFFORD LN
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416-3465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-874-1782
-----------------------------------------------------
Fax | 970-874-7785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 STAFFORD LN
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416-3465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-874-1782
-----------------------------------------------------
Fax | 970-874-7785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 1-15236
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0023039
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------