Provider Demographics
NPI:1760766646
Name:DORVAL, EVELYNE VINCENT (RPH)
Entity Type:Individual
Prefix:
First Name:EVELYNE
Middle Name:VINCENT
Last Name:DORVAL
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 1:832 MIDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1459
Mailing Address - Country:US
Mailing Address - Phone:718-510-6335
Mailing Address - Fax:
Practice Address - Street 1:832 MIDWOOD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1459
Practice Address - Country:US
Practice Address - Phone:718-510-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist