Provider Demographics
NPI:1619592656
Name:VALLANGEON, JOHN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:VALLANGEON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4565
Mailing Address - Country:US
Mailing Address - Phone:219-241-1544
Mailing Address - Fax:
Practice Address - Street 1:525 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3833
Practice Address - Country:US
Practice Address - Phone:219-326-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027217A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist