Provider Demographics
NPI:1225216492
Name:AYALA, EVETTE M (RPH)
Entity Type:Individual
Prefix:MS
First Name:EVETTE
Middle Name:M
Last Name:AYALA
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 1:9470 134TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2550
Mailing Address - Country:US
Mailing Address - Phone:718-641-8587
Mailing Address - Fax:
Practice Address - Street 1:15601 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2746
Practice Address - Country:US
Practice Address - Phone:718-641-9853
Practice Address - Fax:718-738-6884
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037344-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY037344-1OtherRPH LICENSE