Provider Demographics
NPI:1487267803
Name:VALDEZ, JOSEPH T (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:VALDEZ
Suffix:
Gender:M
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:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140-0609
Mailing Address - Country:US
Mailing Address - Phone:719-274-5109
Mailing Address - Fax:719-274-4214
Practice Address - Street 1:412 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-5034
Practice Address - Country:US
Practice Address - Phone:719-274-5109
Practice Address - Fax:719-274-4214
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist