Provider Demographics
NPI:1093237141
Name:MOTTOLA, VICTORIA CAROLINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CAROLINA
Last Name:MOTTOLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 NW 1ST ST APT 105
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7522
Mailing Address - Country:US
Mailing Address - Phone:954-736-8603
Mailing Address - Fax:
Practice Address - Street 1:1200 LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-1115
Practice Address - Country:US
Practice Address - Phone:561-266-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist