Provider Demographics
NPI:1508172024
Name:VIFQUAIN, ANNETTE SANTOS (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:SANTOS
Last Name:VIFQUAIN
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 1:658 SE 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-7610
Mailing Address - Country:US
Mailing Address - Phone:713-859-4644
Mailing Address - Fax:
Practice Address - Street 1:658 SE 66TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7610
Practice Address - Country:US
Practice Address - Phone:713-859-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00124591835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care