Provider Demographics
NPI:1295018810
Name:VALLEJO, LORIBETH (DOCTORATE PHARMACY)
Entity Type:Individual
Prefix:
First Name:LORIBETH
Middle Name:
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:DOCTORATE PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 E 18TH ST
Mailing Address - Street 2:WALGREENS
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2184
Mailing Address - Country:US
Mailing Address - Phone:973-925-8885
Mailing Address - Fax:
Practice Address - Street 1:639 E 18TH ST
Practice Address - Street 2:WALGREENS
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2184
Practice Address - Country:US
Practice Address - Phone:973-925-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03386400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist