Provider Demographics
NPI:1285917484
Name:WEDOE, VALERIE JEANNE (RPH)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEANNE
Last Name:WEDOE
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 1:1855 SILVER BELL RD
Mailing Address - Street 2:#120
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1178
Mailing Address - Country:US
Mailing Address - Phone:952-200-9597
Mailing Address - Fax:
Practice Address - Street 1:5801 W 16TH ST
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1446
Practice Address - Country:US
Practice Address - Phone:763-582-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist