Provider Demographics
NPI:1740909407
Name:FITZE-VALLIER, CORINA RAE (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:RAE
Last Name:FITZE-VALLIER
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 OYSTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4464
Mailing Address - Country:US
Mailing Address - Phone:979-299-0105
Mailing Address - Fax:
Practice Address - Street 1:97 OYSTER CREEK DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4464
Practice Address - Country:US
Practice Address - Phone:979-299-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148889183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician