Provider Demographics
NPI:1528169760
Name:VALLE, LILLIAM M (RPH)
Entity type:Individual
Prefix:MRS
First Name:LILLIAM
Middle Name:M
Last Name:VALLE
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:PO BOX 11175
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1175
Mailing Address - Country:US
Mailing Address - Phone:787-785-2458
Mailing Address - Fax:787-785-2458
Practice Address - Street 1:Z1 AVE CARLOS JAVIER ANDALUZ
Practice Address - Street 2:URB. LOMAS VERDES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3467
Practice Address - Country:US
Practice Address - Phone:787-785-2458
Practice Address - Fax:787-785-2458
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist