Provider Demographics
NPI:1275942344
Name:SPAGNOLO, VANITA SUZANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VANITA
Middle Name:SUZANNE
Last Name:SPAGNOLO
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 1:6 CAREY CT
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2842
Mailing Address - Country:US
Mailing Address - Phone:727-515-1157
Mailing Address - Fax:
Practice Address - Street 1:6 CAREY CT
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-2842
Practice Address - Country:US
Practice Address - Phone:727-515-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist