Provider Demographics
NPI:1609492487
Name:MYATT, VANYA DOREL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VANYA
Middle Name:DOREL
Last Name:MYATT
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 1:2280 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8503
Mailing Address - Country:US
Mailing Address - Phone:517-258-0002
Mailing Address - Fax:
Practice Address - Street 1:2280 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8503
Practice Address - Country:US
Practice Address - Phone:517-258-0002
Practice Address - Fax:517-292-7016
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302043085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist