MEDICARE: RAY VASQUEZ PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	43607	TX

General Provider Information

NPI Number	:	1245568450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAY VASQUEZ PHARM D.

Provider Business Mailing Address
First Line	:	300 ST JOSEPH PKWY APT 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8609
Country	:	US
Telephone Number	:	915-204-5777
Fax Number	:

Provider Business Practice Location Address
First Line	:	8106 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-2120
Country	:	US
Telephone Number	:	713-738-8078
Fax Number	:	713-738-6879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2009
Last Update Date	:	11/28/2009

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