Provider Demographics
NPI:1386994168
Name:TALAVERA, IVETTE Y (PHARMD)
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:Y
Last Name:TALAVERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:IVETTE
Other - Middle Name:Y
Other - Last Name:TREVIZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:191 W LOOP 1604 S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4191
Mailing Address - Country:US
Mailing Address - Phone:210-868-6735
Mailing Address - Fax:210-868-6726
Practice Address - Street 1:191 W LOOP 1604 S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-4191
Practice Address - Country:US
Practice Address - Phone:210-868-6735
Practice Address - Fax:210-868-6726
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist