Provider Demographics
NPI:1942320221
Name:VAZQUEZ, GERARDO Z (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:Z
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 1:5881 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4618
Mailing Address - Country:US
Mailing Address - Phone:954-721-8026
Mailing Address - Fax:954-720-8403
Practice Address - Street 1:5881 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4618
Practice Address - Country:US
Practice Address - Phone:954-721-8026
Practice Address - Fax:954-720-8403
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 32181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist