Provider Demographics
NPI:1477864494
Name:VALADEZ, DAVID ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:VALADEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-5044
Mailing Address - Country:US
Mailing Address - Phone:361-664-2498
Mailing Address - Fax:361-396-0219
Practice Address - Street 1:1055 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-5044
Practice Address - Country:US
Practice Address - Phone:361-664-2498
Practice Address - Fax:361-396-0219
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist