Provider Demographics
NPI:1629393806
Name:VAIS, MARIA (BS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:VAIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1606
Mailing Address - Country:US
Mailing Address - Phone:631-585-8585
Mailing Address - Fax:
Practice Address - Street 1:1036 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1606
Practice Address - Country:US
Practice Address - Phone:631-585-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist