Provider Demographics
NPI:1659989473
Name:VEGA, FERNANDO JESUS (PHARMD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JESUS
Last Name:VEGA
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 1:14630 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8065
Mailing Address - Country:US
Mailing Address - Phone:305-226-0210
Mailing Address - Fax:
Practice Address - Street 1:14630 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8065
Practice Address - Country:US
Practice Address - Phone:305-226-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist