Provider Demographics
NPI:1639775125
Name:IRIZARRY VEGA, CAMILLE CORAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:CORAL
Last Name:IRIZARRY VEGA
Suffix:
Gender:F
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:URB. LOS CAOBOS CALLE ALBIZIA 1075
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-298-7908
Mailing Address - Fax:
Practice Address - Street 1:URB. TURABO GARDEN
Practice Address - Street 2:CARR. 172
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-653-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist