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NPI Code Detail

MEDICARE: ELLYN SUZANNE VALDES ECHAZU RPH

MEDICARE: ELLYN SUZANNE VALDES ECHAZU RPH
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
1183500000XPharmacist123993MN

General Provider Information

NPI Number : 1609472232
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLYN SUZANNE VALDES ECHAZU RPH
Provider Business Mailing Address
First Line : 4318 PLEASANT AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55409-1922
Country : US
Telephone Number : 763-923-4668
Fax Number :
Provider Business Practice Location Address
First Line : 3808 NICOLLET AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55409-1304
Country : US
Telephone Number : 612-822-7946
Fax Number : 612-677-3098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2020
Last Update Date : 03/02/2026

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