Provider Demographics
NPI:1033691365
Name:VILLACAMPA, ALAN
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:VILLACAMPA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:VILLACAMPA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2815 NW 13TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2879
Mailing Address - Country:US
Mailing Address - Phone:352-204-5640
Mailing Address - Fax:
Practice Address - Street 1:2815 NW 13TH ST STE 204
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609
Practice Address - Country:US
Practice Address - Phone:352-204-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist