Provider Demographics
NPI:1104076215
Name:MYALIL, MAYA ABBY (RPH)
Entity type:Individual
Prefix:MS
First Name:MAYA
Middle Name:ABBY
Last Name:MYALIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5730
Mailing Address - Country:US
Mailing Address - Phone:904-434-1114
Mailing Address - Fax:
Practice Address - Street 1:3088 COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5730
Practice Address - Country:US
Practice Address - Phone:904-434-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS346071835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric