Provider Demographics
NPI:1730628967
Name:CORONADO, VALERIE NICOLE I (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:NICOLE
Last Name:CORONADO
Suffix:I
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:NICOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:15600 N BLACK CANYON HWY
Mailing Address - Street 2:SUITE B135
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4055
Mailing Address - Country:US
Mailing Address - Phone:602-896-0454
Mailing Address - Fax:602-896-0456
Practice Address - Street 1:15600 N BLACK CANYON HWY
Practice Address - Street 2:SUITE B135
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4055
Practice Address - Country:US
Practice Address - Phone:602-896-0454
Practice Address - Fax:602-896-0456
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist