MEDICARE: MS. JESSICA VEGA PHARMD

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	PS40336	FL

General Provider Information

NPI Number	:	1518388107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA VEGA PHARMD

Provider Business Mailing Address
First Line	:	550 TECHNOLOGY PARK
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-7131
Country	:	US
Telephone Number	:	888-315-3395
Fax Number	:	888-315-3270

Provider Business Practice Location Address
First Line	:	550 TECHNOLOGY PARK
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-7131
Country	:	US
Telephone Number	:	888-315-3395
Fax Number	:	888-315-3270

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

Provider Enumeration Date	:	12/27/2013
Last Update Date	:	12/27/2013

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