Provider Demographics
NPI:1114631694
Name:GREGORI VAZQUEZ, LISNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISNEY
Middle Name:
Last Name:GREGORI VAZQUEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0984
Mailing Address - Country:US
Mailing Address - Phone:787-963-7430
Mailing Address - Fax:
Practice Address - Street 1:CARR PR3 KM 82.5 #11
Practice Address - Street 2:CENTRO COMERCIAL HUMACAO SHOPPING
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7073183500000X
FLPS64852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4829710OtherDRIVER LICENSE