Provider Demographics
NPI:1982973608
Name:VALKUCHAK, MARY KAY (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:VALKUCHAK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 BATTLEFIELD BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4517
Mailing Address - Country:US
Mailing Address - Phone:757-548-4217
Mailing Address - Fax:757-548-4013
Practice Address - Street 1:1316 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4517
Practice Address - Country:US
Practice Address - Phone:757-548-4217
Practice Address - Fax:757-548-4013
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist