Provider Demographics
NPI:1558553230
Name:VALE, JEROME V (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:V
Last Name:VALE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 VANDERBURGH DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6166
Mailing Address - Country:US
Mailing Address - Phone:219-548-2095
Mailing Address - Fax:
Practice Address - Street 1:1061 VANDERBURGH DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6166
Practice Address - Country:US
Practice Address - Phone:219-548-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26011759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist