Provider Demographics
NPI:1407107279
Name:JALUFKA, AVIS LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:AVIS
Middle Name:LYNN
Last Name:JALUFKA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LYNNIE
Other - Middle Name:
Other - Last Name:JALUFKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1157 TULLEY RD
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-5129
Mailing Address - Country:US
Mailing Address - Phone:361-649-1306
Mailing Address - Fax:
Practice Address - Street 1:1157 TULLEY RD
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-5129
Practice Address - Country:US
Practice Address - Phone:361-649-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist