Healthcare Provider Details

I. General information

NPI: 1417959321
Provider Name (Legal Business Name): PRITYBALA VALBH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 TECHNOLOGY PARK SUITE 124
LAKE MARY FL
32746-7115
US

IV. Provider business mailing address

19337 SPRING OAK DR
EUSTIS FL
32736-7214
US

V. Phone/Fax

Practice location:
  • Phone: 877-305-7708
  • Fax:
Mailing address:
  • Phone: 352-483-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS33253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: