Provider Demographics
NPI:1942583299
Name:POWERS, VAN (RPH)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:VANNIE
Other - Middle Name:
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:6819 WATT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-3203
Mailing Address - Country:US
Mailing Address - Phone:916-339-0189
Mailing Address - Fax:916-339-0195
Practice Address - Street 1:6819 WATT AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-3203
Practice Address - Country:US
Practice Address - Phone:916-339-0189
Practice Address - Fax:916-339-0195
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist