Provider Demographics
NPI:1477845550
Name:VIRUET-AVILLAN, ROSAURA (RPH)
Entity Type:Individual
Prefix:
First Name:ROSAURA
Middle Name:
Last Name:VIRUET-AVILLAN
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 1:103 RT 940
Mailing Address - Street 2:
Mailing Address - City:MT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344
Mailing Address - Country:US
Mailing Address - Phone:570-839-3797
Mailing Address - Fax:
Practice Address - Street 1:103 RT 940
Practice Address - Street 2:
Practice Address - City:MT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344
Practice Address - Country:US
Practice Address - Phone:570-894-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist