Provider Demographics
NPI:1134409865
Name:VALEVICH, GARY (PHARMD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:VALEVICH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:VALEVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2805 OCEAN PKWY
Mailing Address - Street 2:APT 5B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7874
Mailing Address - Country:US
Mailing Address - Phone:917-881-2970
Mailing Address - Fax:
Practice Address - Street 1:4 HENRY ST
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5423
Practice Address - Country:US
Practice Address - Phone:631-462-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist