Provider Demographics
NPI:1104004001
Name:ALVAREZ, AUTUMN AVALON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:AVALON
Last Name:ALVAREZ
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 1:2013 S. JEFFERSON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-915-3355
Mailing Address - Fax:
Practice Address - Street 1:2013 S. JEFFERSON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-915-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist