Provider Demographics
NPI:1457534505
Name:VALENTI, ELISA ROSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:ROSA
Last Name:VALENTI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 78TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2902
Mailing Address - Country:US
Mailing Address - Phone:347-217-3458
Mailing Address - Fax:
Practice Address - Street 1:71-30 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-4601
Practice Address - Country:US
Practice Address - Phone:718-456-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist