Provider Demographics
NPI:1922718071
Name:DELOS REYES, PAULA VIANCA PABUSTAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAULA VIANCA
Middle Name:PABUSTAN
Last Name:DELOS REYES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:PAULA VIANCA
Other - Middle Name:MAGAT
Other - Last Name:PABUSTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:914 S SCHEUBER RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:914 S SCHEUBER RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9027
Practice Address - Country:US
Practice Address - Phone:360-827-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61311186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist