Provider Demographics
NPI:1609472232
Name:VALDES ECHAZU, ELLYN SUZANNE (RPH)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:SUZANNE
Last Name:VALDES ECHAZU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ELLYN
Other - Middle Name:SUZANNE
Other - Last Name:VALDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4318 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1922
Mailing Address - Country:US
Mailing Address - Phone:763-923-4668
Mailing Address - Fax:
Practice Address - Street 1:1276 TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1064
Practice Address - Country:US
Practice Address - Phone:651-686-0392
Practice Address - Fax:612-686-0418
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist