Provider Demographics
NPI:1881498459
Name:VALCOURT, CLONISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CLONISE
Middle Name:
Last Name:VALCOURT
Suffix:
Gender:
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:PO BOX 2025
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33883-2025
Mailing Address - Country:US
Mailing Address - Phone:707-742-7197
Mailing Address - Fax:
Practice Address - Street 1:35800 US HWY 27 N
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3735
Practice Address - Country:US
Practice Address - Phone:707-742-7197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS68581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist