Provider Demographics
NPI:1861856171
Name:VARGAS, CELERINO (RPH)
Entity Type:Individual
Prefix:
First Name:CELERINO
Middle Name:
Last Name:VARGAS
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 1:2238 S EUCLID AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6503
Mailing Address - Country:US
Mailing Address - Phone:909-627-3835
Mailing Address - Fax:909-395-8487
Practice Address - Street 1:2238 S EUCLID AVE STE A
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6503
Practice Address - Country:US
Practice Address - Phone:909-627-3835
Practice Address - Fax:909-395-8487
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist