Provider Demographics
NPI:1497882492
Name:VALENTINE, ELIZABETH MICHELLE IV (MS, R PH)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:VALENTINE
Suffix:IV
Gender:F
Credentials:MS, R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-2111
Mailing Address - Country:US
Mailing Address - Phone:425-350-5969
Mailing Address - Fax:
Practice Address - Street 1:1501 W HORIZON DR
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-2111
Practice Address - Country:US
Practice Address - Phone:425-350-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist