Provider Demographics
NPI:1306139498
Name:VEGA, GRISELLE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GRISELLE
Middle Name:
Last Name:VEGA
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:IRLANDA HEIGHTS GEMINIS
Mailing Address - Street 2:FH2
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-466-0186
Mailing Address - Fax:
Practice Address - Street 1:IRLANDA HEIGHTS GEMENIS
Practice Address - Street 2:FH2
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00956
Practice Address - Country:UM
Practice Address - Phone:787-466-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0061OtherFARMACEUTICO INMUNIZADOR