Provider Demographics
NPI:1093980260
Name:VALENTINE, JOHNA (RPH)
Entity Type:Individual
Prefix:
First Name:JOHNA
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:GIANG
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DS
Mailing Address - Street 1:815 VINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1460
Mailing Address - Country:US
Mailing Address - Phone:708-839-1321
Mailing Address - Fax:708-839-1561
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:BLDG 37 NW
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-786-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist