Provider Demographics
NPI:1336680487
Name:VALENCIA, DANIELA (DOCTORATE PHARMACY)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:VALENCIA
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 1:4314 DOUGLASTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1540
Mailing Address - Country:US
Mailing Address - Phone:917-509-9558
Mailing Address - Fax:
Practice Address - Street 1:5425 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2405
Practice Address - Country:US
Practice Address - Phone:718-444-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist