Provider Demographics
NPI:1538986468
Name:DEL VALLE, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DEL VALLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 SW 69TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-6450
Mailing Address - Country:US
Mailing Address - Phone:786-369-6243
Mailing Address - Fax:
Practice Address - Street 1:2765 NW 49TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-6214
Practice Address - Country:US
Practice Address - Phone:786-369-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist