MEDICARE: MR. CARLOS D VARGAS PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	00312	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001312	OTHER	PR	PHARMACIST

General Provider Information

NPI Number	:	1508497207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS D VARGAS PHARMACIST

Provider Business Mailing Address
First Line	:	PO BOX 832
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00613-0832
Country	:	US
Telephone Number	:	787-618-3348
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 CALLE SAN FELIPE
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-4605
Country	:	US
Telephone Number	:	787-878-1120
Fax Number	:	787-817-4678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	01/31/2020

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