Provider Demographics
NPI:1295162782
Name:PFAB, VINCENT C (RPH)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:C
Last Name:PFAB
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 1:549 FOX HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5402
Mailing Address - Country:US
Mailing Address - Phone:904-540-1677
Mailing Address - Fax:
Practice Address - Street 1:549 FOX HOLLOW LN
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5402
Practice Address - Country:US
Practice Address - Phone:904-540-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24385183500000X
VA0202009349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist