Provider Demographics
NPI:1467092148
Name:DIAZ VAZQUEZ, EMANUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:DIAZ VAZQUEZ
Suffix:
Gender:M
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:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-1368
Mailing Address - Country:US
Mailing Address - Phone:787-608-3345
Mailing Address - Fax:787-857-5249
Practice Address - Street 1:CARR. 152 KM 2.8 BO. QUEBRADILLAS
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-857-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist