Provider Demographics
NPI:1598042129
Name:COMPTON-BAUSWELL, VALENCIA
Entity Type:Individual
Prefix:DR
First Name:VALENCIA
Middle Name:
Last Name:COMPTON-BAUSWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 S KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2440
Mailing Address - Country:US
Mailing Address - Phone:832-655-6796
Mailing Address - Fax:773-874-0173
Practice Address - Street 1:8628 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6108
Practice Address - Country:US
Practice Address - Phone:773-651-8500
Practice Address - Fax:773-874-0173
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290760183500000X
TX40973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist