Provider Demographics
NPI:1326389073
Name:PALLA, JOAN NAN (RPH)
Entity Type:Individual
Prefix:MISS
First Name:JOAN
Middle Name:NAN
Last Name:PALLA
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 1:3002 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1802
Mailing Address - Country:US
Mailing Address - Phone:254-773-2177
Mailing Address - Fax:254-770-1759
Practice Address - Street 1:3002 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1802
Practice Address - Country:US
Practice Address - Phone:254-773-2177
Practice Address - Fax:254-770-1759
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist