Provider Demographics
NPI:1518248095
Name:VASKO, REGINA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:VASKO
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 1:2110 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3306
Mailing Address - Country:US
Mailing Address - Phone:772-283-1045
Mailing Address - Fax:772-283-9797
Practice Address - Street 1:2110 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3306
Practice Address - Country:US
Practice Address - Phone:772-283-1045
Practice Address - Fax:772-283-9797
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist