Provider Demographics
NPI:1619517802
Name:VERGARA, JOSE ANGEL SR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:VERGARA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FARMACIAS CARIDAD PLAZA DEL CARMEN MALL
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-743-1273
Mailing Address - Fax:787-743-5929
Practice Address - Street 1:AVE PINO LOCAL 51 PLAZA DEL CARMEN MALL
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-1273
Practice Address - Fax:787-743-5929
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist