Provider Demographics
NPI:1134202047
Name:ROSARIO-VAZQUEZ, LIDIAN JANNET (BSPH)
Entity type:Individual
Prefix:MRS
First Name:LIDIAN
Middle Name:JANNET
Last Name:ROSARIO-VAZQUEZ
Suffix:
Gender:F
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. CAMINO REAL
Mailing Address - Street 2:BUZON 29
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-744-6773
Mailing Address - Fax:787-714-1444
Practice Address - Street 1:FRANCISCO CRUZ HADDOCK #2
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-8182
Practice Address - Fax:787-739-8190
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist