Provider Demographics
NPI:1346516523
Name:CHWALINSKI, VIVIAN LOUISE (PD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:LOUISE
Last Name:CHWALINSKI
Suffix:
Gender:F
Credentials:PD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:LOUISE
Other - Last Name:CHWALINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DVM
Mailing Address - Street 1:704 LONG ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2917
Mailing Address - Country:US
Mailing Address - Phone:479-739-8600
Mailing Address - Fax:
Practice Address - Street 1:704 LONG ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2917
Practice Address - Country:US
Practice Address - Phone:479-739-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2325174M00000X
ARPD07069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174M00000XOther Service ProvidersVeterinarian