Organization
VALPARASIO PROFESSIONAL PHARMACY, P.C.
Active
Other names
VALPARAISO PROFESSIONAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELTON L VANDERTUIN RPH (OWNER)
(219) 462-1484
Entity
Organization
Contact information
Practice address
3540 CALUMET AVE, VALPARAISO, IN 46383-2246
(219) 462-1484
(219) 465-4199
Mailing address
3540 CALUMET AVE, VALPARAISO, IN 46383-2246
(219) 462-1484
(219) 465-4199
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
60006597
IN
333600000X
Pharmacy
60006597
IN
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60005539A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100300380
—
IN
01
—
2025017
PK
—
Enumeration date
08/31/2006
Last updated
11/15/2022
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