Provider Demographics
NPI:1215309513
Name:VARGAS, CARMEN B
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:B
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FF9 CALLE 9
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-5637
Mailing Address - Country:US
Mailing Address - Phone:939-232-1199
Mailing Address - Fax:
Practice Address - Street 1:FF9 CALLE 9
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-5637
Practice Address - Country:US
Practice Address - Phone:939-232-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00417183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR004417OtherPHARMACY TEC