Provider Demographics
NPI:1982760062
Name:VANVALKENBURG, DAVID ELWIN (RPH, CO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ELWIN
Last Name:VANVALKENBURG
Suffix:
Gender:M
Credentials:RPH, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HAYNES BLVD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1311
Mailing Address - Country:US
Mailing Address - Phone:607-563-8615
Mailing Address - Fax:607-563-8615
Practice Address - Street 1:37 MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1139
Practice Address - Country:US
Practice Address - Phone:607-563-7000
Practice Address - Fax:607-563-1762
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist