Provider Demographics
NPI:1194470831
Name:VAGENAS, VASILIOS SPIROS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VASILIOS
Middle Name:SPIROS
Last Name:VAGENAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 GRAND AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4260
Mailing Address - Country:US
Mailing Address - Phone:626-241-8315
Mailing Address - Fax:
Practice Address - Street 1:5901 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-3303
Practice Address - Country:US
Practice Address - Phone:515-331-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist