Provider Demographics
NPI:1134135304
Name:VAZQUEZ, NIMIA I (RPH, MBA)
Entity Type:Individual
Prefix:MRS
First Name:NIMIA
Middle Name:I
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 93716
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9613
Mailing Address - Country:US
Mailing Address - Phone:787-878-6665
Mailing Address - Fax:787-878-6665
Practice Address - Street 1:ST. 129 KM 5.0 BO. HATO ARRIBA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-6665
Practice Address - Fax:787-878-6665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08F2397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist