Healthcare Provider Details

I. General information

NPI: 1699601617
Provider Name (Legal Business Name): GIANCOB VEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

3640 BELMONT ST APT C
GREENSBORO NC
27406-4949
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-2374
  • Fax:
Mailing address:
  • Phone: 336-901-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number69410
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: