Provider Demographics
NPI:1275655300
Name:VAAL, JOHN PAUL
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:VAAL
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 1:1206 MOCKINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41018-2609
Mailing Address - Country:US
Mailing Address - Phone:859-341-0261
Mailing Address - Fax:
Practice Address - Street 1:118 6TH AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:KY
Practice Address - Zip Code:41074-1112
Practice Address - Country:US
Practice Address - Phone:859-491-1700
Practice Address - Fax:859-491-7680
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist