Provider Demographics
NPI:1760975973
Name:POWE, VALDEZ
Entity Type:Individual
Prefix:
First Name:VALDEZ
Middle Name:
Last Name:POWE
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 1:101 E I65 SERVICE RD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3900
Mailing Address - Country:US
Mailing Address - Phone:251-471-2771
Mailing Address - Fax:251-471-2808
Practice Address - Street 1:101 E I65 SERVICE RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3900
Practice Address - Country:US
Practice Address - Phone:251-471-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist