Provider Demographics
NPI:1508188871
Name:VALLEY, MARK MERRITT (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MERRITT
Last Name:VALLEY
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 1:6600 M 66 N
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9505
Mailing Address - Country:US
Mailing Address - Phone:231-547-0915
Mailing Address - Fax:
Practice Address - Street 1:220 S GENESSEE ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615-9651
Practice Address - Country:US
Practice Address - Phone:231-533-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist