Provider Demographics
NPI:1013562321
Name:VALVERDE, DANIEL GLENN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:GLENN
Last Name:VALVERDE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18106 ROAD 25
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-9255
Mailing Address - Country:US
Mailing Address - Phone:505-249-4352
Mailing Address - Fax:
Practice Address - Street 1:1835 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3037
Practice Address - Country:US
Practice Address - Phone:970-565-7038
Practice Address - Fax:970-565-0105
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist