Provider Demographics
NPI:1043523418
Name:VALENCIA, DANIEL (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 ELIZABETH ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2220
Mailing Address - Country:US
Mailing Address - Phone:361-882-3636
Mailing Address - Fax:361-882-3638
Practice Address - Street 1:613 ELIZABETH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2220
Practice Address - Country:US
Practice Address - Phone:361-882-3636
Practice Address - Fax:361-882-3638
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist