Provider Demographics
NPI:1386273613
Name:VALENTIN, ELAINE LEA GUDGER (CPHT)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:LEA GUDGER
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 479 BOX 15
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09263-0001
Mailing Address - Country:US
Mailing Address - Phone:256-850-4647
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:DR. HITZELBERGER STRASSE
Practice Address - City:LANDSTUHL
Practice Address - State:RHEINLAND-PFALZ
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-590-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT56206183700000X
T7W4C8R9183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician