Provider Demographics
NPI:1710571666
Name:ZAVALA, JAQUELINE YARELI (PHARMD)
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:YARELI
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9852 S US HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-7240
Mailing Address - Country:US
Mailing Address - Phone:903-948-9154
Mailing Address - Fax:
Practice Address - Street 1:1710 PLUM ST
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550
Practice Address - Country:US
Practice Address - Phone:512-556-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83683183500000X
TX67971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist