Provider Demographics
NPI:1275198772
Name:VILLANUEVA, FRANCISCO JACIEL
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:JACIEL
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 ALMA RD NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3793
Mailing Address - Country:US
Mailing Address - Phone:509-761-8161
Mailing Address - Fax:
Practice Address - Street 1:4690 ALMA RD NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-3793
Practice Address - Country:US
Practice Address - Phone:509-761-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician