Provider Demographics
NPI:1396964441
Name:IADANZA-BRUMBACH, VALERIE M (RPH)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:M
Last Name:IADANZA-BRUMBACH
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 1:6 SPINNING WHEEL LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-5319
Mailing Address - Country:US
Mailing Address - Phone:856-784-1892
Mailing Address - Fax:
Practice Address - Street 1:6 SPINNING WHEEL LN
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-5319
Practice Address - Country:US
Practice Address - Phone:856-784-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02630800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02630800OtherPHARMACIST LICENSE NUMBER