Provider Demographics
NPI:1871196063
Name:VALLE, MARIA D (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:VALLE
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:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-6146
Mailing Address - Country:US
Mailing Address - Phone:617-543-3969
Mailing Address - Fax:
Practice Address - Street 1:1099 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2418
Practice Address - Country:US
Practice Address - Phone:860-236-6181
Practice Address - Fax:860-231-1365
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0007823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist