Provider Demographics
NPI:1639381411
Name:VAVALA, JUDE STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JUDE
Middle Name:STEPHEN
Last Name:VAVALA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W THERESIA RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-2623
Mailing Address - Country:US
Mailing Address - Phone:814-781-1452
Mailing Address - Fax:814-834-1031
Practice Address - Street 1:4 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1729
Practice Address - Country:US
Practice Address - Phone:814-834-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027024L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist