MEDICARE: MRS. JACQUELINE VALDES PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS40513	FL

General Provider Information

NPI Number	:	1528345949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE VALDES PHARMD

Provider Business Mailing Address
First Line	:	14075 BISCAYNE BLVD
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1629
Country	:	US
Telephone Number	:	305-944-8103
Fax Number	:	305-945-8346

Provider Business Practice Location Address
First Line	:	14075 BISCAYNE BLVD
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1629
Country	:	US
Telephone Number	:	305-944-8103
Fax Number	:	305-945-8346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	11/14/2011

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