Provider Demographics
NPI:1598158214
Name:VERGARA, VERN LLOYD (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:VERN
Middle Name:LLOYD
Last Name:VERGARA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 ROCKHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-2902
Mailing Address - Country:US
Mailing Address - Phone:510-928-5754
Mailing Address - Fax:
Practice Address - Street 1:1871 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4106
Practice Address - Country:US
Practice Address - Phone:925-979-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist