Provider Demographics
NPI:1609067313
Name:VAZQUEZ-MARRERO, BENIGNO (RPH)
Entity Type:Individual
Prefix:
First Name:BENIGNO
Middle Name:
Last Name:VAZQUEZ-MARRERO
Suffix:
Gender:M
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:PLAYA DORADA COND. #212-A
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-7039
Mailing Address - Country:US
Mailing Address - Phone:787-688-5066
Mailing Address - Fax:
Practice Address - Street 1:LOTE #5 CABRERA DEVELOPMENT
Practice Address - Street 2:SALTO ARRIBA WD,
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-3035
Practice Address - Country:US
Practice Address - Phone:787-894-6555
Practice Address - Fax:787-894-2550
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist