Provider Demographics
NPI:1538337704
Name:DEL VALLE, THERESA ANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANNE
Last Name:DEL 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 1:79 AARON DR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-4302
Mailing Address - Country:US
Mailing Address - Phone:609-597-5856
Mailing Address - Fax:
Practice Address - Street 1:517 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2821
Practice Address - Country:US
Practice Address - Phone:609-978-8510
Practice Address - Fax:609-978-1685
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02215100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02215100OtherRPH STATE LICENSE NUMBER