Provider Demographics
NPI:1710694807
Name:VALLE, ELMON RAEL
Entity Type:Individual
Prefix:
First Name:ELMON RAEL
Middle Name:
Last Name:VALLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 EASTSHORE PL UNIT G107
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-0008
Mailing Address - Country:US
Mailing Address - Phone:209-505-8847
Mailing Address - Fax:
Practice Address - Street 1:3495 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4503
Practice Address - Country:US
Practice Address - Phone:775-824-0802
Practice Address - Fax:775-824-0808
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist