Healthcare Provider Details

I. General information

NPI: 1306409958
Provider Name (Legal Business Name): ALFONSO EDUARD VERCUEIL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26891 ALISO CREEK RD
ALISO VIEJO CA
92656-3392
US

IV. Provider business mailing address

4 VARESA
IRVINE CA
92620-2566
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-4081
  • Fax:
Mailing address:
  • Phone: 949-533-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: