Provider Demographics
NPI:1063507085
Name:MINNICH, VALERIE II
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:
Last Name:MINNICH
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 WESTBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-8806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:606 WESTBROOKE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-8806
Practice Address - Country:US
Practice Address - Phone:610-670-4127
Practice Address - Fax:610-670-4116
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-08537-L183500000X
NJ28RI02511200183500000X
VA0202010908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist