Provider Demographics
NPI:1821323130
Name:VONGLAHN, JAIME VICTORIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:VICTORIA
Last Name:VONGLAHN
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 1:9061 N PALM BROOK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-8928
Mailing Address - Country:US
Mailing Address - Phone:520-579-3105
Mailing Address - Fax:
Practice Address - Street 1:4150 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-5335
Practice Address - Country:US
Practice Address - Phone:520-571-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist