Provider Demographics
NPI:1780933382
Name:MOSTERT, VALERIE (MD)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:MOSTERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16750 WEST BELL ROAD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9539
Mailing Address - Country:US
Mailing Address - Phone:623-546-8247
Mailing Address - Fax:623-546-3793
Practice Address - Street 1:16750 WEST BELL ROAD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9539
Practice Address - Country:US
Practice Address - Phone:623-546-8247
Practice Address - Fax:623-546-3793
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist