Provider Demographics
NPI:1508567686
Name:REVILLS, VICTORIA ALECE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ALECE
Last Name:REVILLS
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 1:1082 HAILEY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8206
Mailing Address - Country:US
Mailing Address - Phone:321-507-5484
Mailing Address - Fax:
Practice Address - Street 1:1060 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8937
Practice Address - Country:US
Practice Address - Phone:321-241-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist