Provider Demographics
NPI:1144590886
Name:VAILE, JOHN INGRAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:INGRAM
Last Name:VAILE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29140 MEDEA LN
Mailing Address - Street 2:APT 1114
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-6410
Mailing Address - Country:US
Mailing Address - Phone:201-638-4315
Mailing Address - Fax:
Practice Address - Street 1:29140 MEDEA LN
Practice Address - Street 2:APT 1114
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-6410
Practice Address - Country:US
Practice Address - Phone:201-638-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist