Provider Demographics
NPI:1720497381
Name:ALVES, MARIANNA (PHARMD, DDS)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:ALVES
Suffix:
Gender:M
Credentials:PHARMD, DDS
Other - Prefix:DR
Other - First Name:MARIANNA
Other - Middle Name:
Other - Last Name:VALADAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:252 CHENEY DR W
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3721
Mailing Address - Country:US
Mailing Address - Phone:208-736-3387
Mailing Address - Fax:208-736-3738
Practice Address - Street 1:252 CHENEY DR W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3721
Practice Address - Country:US
Practice Address - Phone:208-736-3387
Practice Address - Fax:208-736-3738
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist