Provider Demographics
NPI:1699799700
Name:VEGA RIOS, MARIBEL (RPH)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:VEGA RIOS
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:COND. GARDEN CENTER #1 2
Mailing Address - Street 2:UNIVERSITY GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4853
Mailing Address - Country:US
Mailing Address - Phone:787-763-1059
Mailing Address - Fax:787-763-1074
Practice Address - Street 1:COND GARDEN CEN #1 2
Practice Address - Street 2:UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4853
Practice Address - Country:US
Practice Address - Phone:787-763-1059
Practice Address - Fax:787-763-1074
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1260520001Medicare NSC