Healthcare Provider Details

I. General information

NPI: 1639410905
Provider Name (Legal Business Name): YANINA VIGNONI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18433 N 19TH AVE
PHOENIX AZ
85023-1359
US

IV. Provider business mailing address

18433 N 19TH AVE
PHOENIX AZ
85023-1359
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-9894
  • Fax:
Mailing address:
  • Phone: 623-582-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019634
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: