Provider Demographics
NPI:1124295100
Name:VANCE, SAFIYA N (PHARM D)
Entity type:Individual
Prefix:MISS
First Name:SAFIYA
Middle Name:N
Last Name:VANCE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 WENTWORTH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6044
Mailing Address - Country:US
Mailing Address - Phone:832-428-9411
Mailing Address - Fax:
Practice Address - Street 1:2580 SHEARN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3967
Practice Address - Country:US
Practice Address - Phone:713-331-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist