Provider Demographics
NPI:1487293528
Name:VEGA, MARIA JOSEFINA (RPH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSEFINA
Last Name:VEGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CAMINO PANORAMICO
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6157
Mailing Address - Country:US
Mailing Address - Phone:787-450-3858
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN JOSE #4 NORTE
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-3355
Practice Address - Fax:787-737-5441
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2282OtherPHARMACIST LICENSE