Provider Demographics
NPI:1396402202
Name:VARGAS, DAISY IVANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:IVANA
Last Name:VARGAS
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 1:1525 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1021
Mailing Address - Country:US
Mailing Address - Phone:239-939-2191
Mailing Address - Fax:
Practice Address - Street 1:4018 E SUNFLOWER CIR
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-5528
Practice Address - Country:US
Practice Address - Phone:305-316-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist