Provider Demographics
NPI:1437753399
Name:PETROVSKY, VALERIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:PETROVSKY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 BEAL PKWY NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1439
Mailing Address - Country:US
Mailing Address - Phone:850-863-4400
Mailing Address - Fax:
Practice Address - Street 1:1081 BEAL PKWY NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1439
Practice Address - Country:US
Practice Address - Phone:850-863-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist