Provider Demographics
NPI:1306621826
Name:BOOKWALTER, VALERIE LEA
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:LEA
Last Name:BOOKWALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 CONGRESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-4440
Mailing Address - Country:US
Mailing Address - Phone:260-668-9007
Mailing Address - Fax:401-652-1406
Practice Address - Street 1:3402 CONGRESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-4440
Practice Address - Country:US
Practice Address - Phone:260-668-9007
Practice Address - Fax:401-652-1406
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020722A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist