Healthcare Provider Details

I. General information

NPI: 1437738523
Provider Name (Legal Business Name): JULIMAR VAZQUEZ PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 VEGA ALTA PR CARR 694
VEGA ALTA PR
00692
US

IV. Provider business mailing address

HC 1 BOX 4346
COROZAL PR
00783-9331
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-0460
  • Fax:
Mailing address:
  • Phone: 787-359-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number010059
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: