Provider Demographics
NPI:1437325149
Name:VEGA, WANDA IVETTE (PHTECH)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:IVETTE
Last Name:VEGA
Suffix:
Gender:F
Credentials:PHTECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 04 BOX 17692
Mailing Address - Street 2:SECTOR LOS PADINES, CAMUY ARRIBA
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9704
Mailing Address - Country:US
Mailing Address - Phone:787-201-2808
Mailing Address - Fax:787-816-5837
Practice Address - Street 1:HC 04 BOX 17692
Practice Address - Street 2:SECTOR LOS PADINES, CAMUY ARRIBA
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9704
Practice Address - Country:US
Practice Address - Phone:787-201-2808
Practice Address - Fax:787-816-5837
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5525183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician