Provider Demographics
NPI:1295212389
Name:COLON-VAZQUEZ, KATHIA JEANETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHIA
Middle Name:JEANETTE
Last Name:COLON-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 1:727 CALLE FLAMBOYAN
Mailing Address - Street 2:BO CORAZON
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-214-4137
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND PASEO BLVD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5905
Practice Address - Country:US
Practice Address - Phone:787-283-2555
Practice Address - Fax:787-283-2545
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist