Healthcare Provider Details

I. General information

NPI: 1760094650
Provider Name (Legal Business Name): IRENE ZAVALA CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 1ST ST
CHENEY WA
99004-2049
US

IV. Provider business mailing address

2221 1ST ST
CHENEY WA
99004-2049
US

V. Phone/Fax

Practice location:
  • Phone: 509-235-4705
  • Fax:
Mailing address:
  • Phone: 509-235-4705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00062066
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: