Provider Demographics
NPI:1295913044
Name:VALDEZ, IRINA VADIMOVNA
Entity type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:VADIMOVNA
Last Name:VALDEZ
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 1:4246 ALBANY POST RD
Mailing Address - Street 2:SUITE#2
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538
Mailing Address - Country:US
Mailing Address - Phone:845-229-2224
Mailing Address - Fax:845-229-1102
Practice Address - Street 1:4246 ALBANY POST RD
Practice Address - Street 2:SUITE#2
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538
Practice Address - Country:US
Practice Address - Phone:845-229-2224
Practice Address - Fax:845-229-1102
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048633-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist