Provider Demographics
NPI:1306409958
Name:VERCUEIL, ALFONSO EDUARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:EDUARD
Last Name:VERCUEIL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VARESA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2566
Mailing Address - Country:US
Mailing Address - Phone:949-533-9599
Mailing Address - Fax:
Practice Address - Street 1:26891 ALISO CREEK RD
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3392
Practice Address - Country:US
Practice Address - Phone:949-360-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist