Provider Demographics
NPI:1114242534
Name:BROCK, VALERIE J (RPH)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:J
Last Name:BROCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 PLATEAU DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-2375
Mailing Address - Country:US
Mailing Address - Phone:765-497-8642
Mailing Address - Fax:765-497-8593
Practice Address - Street 1:3851 N RIVER RD
Practice Address - Street 2:INDIANA VETERANS' HOME PHARMACY
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-3762
Practice Address - Country:US
Practice Address - Phone:765-497-8642
Practice Address - Fax:765-497-8593
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014555A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist