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General NPI Number Information
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NPI Number | 1396046983
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Entity Type | Individual
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Provider Name | DOMINGA MARQUEZ DE VERA RPH
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Gender | Female
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 475 WEST MAIN STREET VONS PHARMACY
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City | BRAWLEY
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State | CA
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Zip | 92227
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Country | US
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Telephone | 760-351-3007
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Fax | 760-351-3012
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Provider Business Mailing Address
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Address Line | 475 WEST MAIN STREET VONS PHARMACY
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City | BRAWLEY
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State | CA
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Zip | 92227
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Country | US
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Telephone | 760-351-3007
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Fax | 760-351-3012
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 59191
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License Number State | CA
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