Provider Demographics
NPI:1699592980
Name:VALDEZ, ALYSSA M (RPH)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:M
Last Name:VALDEZ
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 1:10224 COORS BYP NW STE 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4398
Mailing Address - Country:US
Mailing Address - Phone:505-897-6935
Mailing Address - Fax:
Practice Address - Street 1:10224 COORS BYP NW STE 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4398
Practice Address - Country:US
Practice Address - Phone:505-897-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00010226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist