Provider Demographics
NPI:1538491436
Name:GORIS-SANCHEZ, VANESSA (RPH)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GORIS-SANCHEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15325 79TH AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3933
Mailing Address - Country:US
Mailing Address - Phone:917-664-4619
Mailing Address - Fax:
Practice Address - Street 1:5711 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4933
Practice Address - Country:US
Practice Address - Phone:718-456-2602
Practice Address - Fax:718-456-2832
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist