Provider Demographics
NPI:1548654692
Name:VILLAMIZAR, PAUL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:VILLAMIZAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CAMBRIDGE DR UNIT 11
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3625
Mailing Address - Country:US
Mailing Address - Phone:561-310-4049
Mailing Address - Fax:
Practice Address - Street 1:900 CAMBRIDGE DRIVE UNIT 11
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510
Practice Address - Country:US
Practice Address - Phone:561-310-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist