Provider Demographics
NPI:1467880815
Name:ALVIS, AMY JONG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:JONG
Last Name:ALVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27991 BUENA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4261
Mailing Address - Country:US
Mailing Address - Phone:956-504-7279
Mailing Address - Fax:756-504-7284
Practice Address - Street 1:27991 BUENA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-4261
Practice Address - Country:US
Practice Address - Phone:956-504-7279
Practice Address - Fax:756-504-7284
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47585183500000X
VA0202207910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist