Provider Demographics
NPI:1558522243
Name:VALES, QUIRICO F JR (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:QUIRICO
Middle Name:F
Last Name:VALES
Suffix:JR
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:MR
Other - First Name:QUIRICO
Other - Middle Name:F
Other - Last Name:VALES
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6824 PANAMINT ROW UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-2815
Mailing Address - Country:US
Mailing Address - Phone:619-267-7760
Mailing Address - Fax:
Practice Address - Street 1:6824 PANAMINT ROW UNIT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-2815
Practice Address - Country:US
Practice Address - Phone:619-267-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45617183700000X
DC260101030761530183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician