Provider Demographics
NPI:1104368307
Name:VAVAL, PAMELA (RPH)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:VAVAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4827 NW 22ND PL
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7761
Mailing Address - Country:US
Mailing Address - Phone:954-740-3980
Mailing Address - Fax:
Practice Address - Street 1:1181 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3322
Practice Address - Country:US
Practice Address - Phone:954-577-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-06
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist