Provider Demographics
NPI:1316221906
Name:KOUTNY, VALERIE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNN
Last Name:KOUTNY
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 1:1525 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1924
Mailing Address - Country:US
Mailing Address - Phone:563-386-6883
Mailing Address - Fax:563-386-6586
Practice Address - Street 1:1525 E KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1924
Practice Address - Country:US
Practice Address - Phone:563-386-6883
Practice Address - Fax:563-386-6586
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist