MEDICARE: MS. YANIRA VAZQUEZ R.PH.

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	4257	PR

General Provider Information

NPI Number	:	1477553220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YANIRA VAZQUEZ R.PH.

Provider Business Mailing Address
First Line	:	2906 BLACKBURN DR
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76543-2696
Country	:	US
Telephone Number	:	254-699-6949
Fax Number	:	254-699-6949

Provider Business Practice Location Address
First Line	:	36000 DARNALL LOOP
Second Line	:	DARNALL ARMY COMMUNITY HOSPITAL, PHARMACY DEPT.
City	:	FORT HOOD
State	:	TX
Zip	:	76544-5095
Country	:	US
Telephone Number	:	254-286-7710
Fax Number	:	254-286-7171

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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