Provider Demographics
NPI:1316547862
Name:VALVERDE, EMMANUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:VALVERDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KINGS FORT PKWY
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-3575
Mailing Address - Country:US
Mailing Address - Phone:469-595-7076
Mailing Address - Fax:
Practice Address - Street 1:300 KINGS FORT PKWY
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-3575
Practice Address - Country:US
Practice Address - Phone:469-595-7076
Practice Address - Fax:469-595-7069
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist