Provider Demographics
NPI:1225638273
Name:KOCH, VALERIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17764 E 2100 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IL
Mailing Address - Zip Code:61748-9207
Mailing Address - Country:US
Mailing Address - Phone:309-533-1320
Mailing Address - Fax:
Practice Address - Street 1:300 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2278
Practice Address - Country:US
Practice Address - Phone:309-451-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist