Provider Demographics
NPI:1376968347
Name:VLADUT-VASILAN, CONSTANTA (RPH)
Entity Type:Individual
Prefix:
First Name:CONSTANTA
Middle Name:
Last Name:VLADUT-VASILAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N ZARAGOZA RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4745
Mailing Address - Country:US
Mailing Address - Phone:915-872-9802
Mailing Address - Fax:915-872-9728
Practice Address - Street 1:411 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4745
Practice Address - Country:US
Practice Address - Phone:915-872-9802
Practice Address - Fax:915-872-9728
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist