Provider Demographics
NPI:1922016476
Name:VAZQUEZ, RAFAEL O (RPH)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:O
Last Name:VAZQUEZ
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 1:1117 CALLE LOS ALMENDROS
Mailing Address - Street 2:P.O.BOX 718
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-2446
Mailing Address - Country:US
Mailing Address - Phone:787-898-6322
Mailing Address - Fax:787-262-2024
Practice Address - Street 1:CARR. 490 KM. 3.2 BO. CAMPO ALEGRE SECTOR PAJUIL
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-1972
Practice Address - Fax:787-898-6239
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist