Provider Demographics
NPI:1861660318
Name:VANGA, PEDRO J (RPH)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:J
Last Name:VANGA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 CALLE JULIO ANDINO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2252
Mailing Address - Country:US
Mailing Address - Phone:787-751-0565
Mailing Address - Fax:787-751-0286
Practice Address - Street 1:730 CALLE JULIO ANDINO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-2252
Practice Address - Country:US
Practice Address - Phone:787-751-0565
Practice Address - Fax:787-751-0286
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist