Provider Demographics
NPI:1518475037
Name:CORTEZ, VINICIA LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VINICIA
Middle Name:LYNN
Last Name:CORTEZ
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 1:9401 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:HOKES BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35903-6868
Mailing Address - Country:US
Mailing Address - Phone:256-399-1104
Mailing Address - Fax:
Practice Address - Street 1:973 GILBERT FERRY RD SE
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-3339
Practice Address - Country:US
Practice Address - Phone:256-538-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist