Provider Demographics
NPI:1871876656
Name:VALA, CHRISTINE LAURA (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LAURA
Last Name:VALA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:CHRIS
Other - Middle Name:L
Other - Last Name:VALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:10 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1676
Mailing Address - Country:US
Mailing Address - Phone:413-589-1017
Mailing Address - Fax:
Practice Address - Street 1:501 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2306
Practice Address - Country:US
Practice Address - Phone:413-746-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist