Provider Demographics
NPI:1417224510
Name:VALDES, WALTER (PHARMD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:VALDES
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 1:525 LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4228
Mailing Address - Country:US
Mailing Address - Phone:626-533-9974
Mailing Address - Fax:
Practice Address - Street 1:5600 WHITTIER BLVD
Practice Address - Street 2:T-0189
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-4106
Practice Address - Country:US
Practice Address - Phone:323-725-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist