Provider Demographics
NPI:1679564298
Name:INGOLDSBY, VALERIE DENISE (RPH)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:DENISE
Last Name:INGOLDSBY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2901
Mailing Address - Country:US
Mailing Address - Phone:321-269-8382
Mailing Address - Fax:
Practice Address - Street 1:1350 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8945
Practice Address - Country:US
Practice Address - Phone:321-254-5507
Practice Address - Fax:321-254-5032
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0024012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist