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General NPI Number Information
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NPI Number | 1649582099
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Entity Type | Individual
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Provider Name | NORMAN NELSON VERGARA BAY RPH
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Gender | Male
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 1380 BARSTOW RD
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City | BARSTOW
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State | CA
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Zip | 92311-4944
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Country | US
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Telephone | 760-252-3502
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Fax |
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Provider Business Mailing Address
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Address Line | 14747 ROSCOE BLVD APT.#23
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4145
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Country | US
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Telephone | 818-216-3289
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Fax |
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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 | 9165747900
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License Number State | CA
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