Provider Demographics
NPI:1962611491
Name:CASTRO, VIVIAN IVONNE (PHARMACIST)
Entity type:Individual
Prefix:MISS
First Name:VIVIAN
Middle Name:IVONNE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SA43 PLAZA 2
Mailing Address - Street 2:URB MANSION DEL SUR
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4845
Mailing Address - Country:US
Mailing Address - Phone:787-795-1705
Mailing Address - Fax:
Practice Address - Street 1:SA43 PLAZA 2
Practice Address - Street 2:URB MANSION DEL SUR
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4845
Practice Address - Country:US
Practice Address - Phone:787-795-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist