Provider Demographics
NPI:1306980610
Name:VEGA, CELESTE ROBIN
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:ROBIN
Last Name:VEGA
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 1:87 ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-9645
Mailing Address - Country:US
Mailing Address - Phone:864-834-5927
Mailing Address - Fax:864-801-0499
Practice Address - Street 1:1402 HIGHWAY 101 S
Practice Address - Street 2:AREA B
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6731
Practice Address - Country:US
Practice Address - Phone:864-801-0411
Practice Address - Fax:864-801-0499
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist