MEDICARE: MRS. PRISCILLA VALLOO BPHARM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	56484	CA

General Provider Information

NPI Number	:	1821389982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRISCILLA VALLOO BPHARM

Provider Business Mailing Address
First Line	:	705 ISLAY ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-4366
Country	:	US
Telephone Number	:	805-439-0711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 CRESTON RD
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-3031
Country	:	US
Telephone Number	:	805-239-3028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	04/25/2011

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