Provider Demographics
NPI:1134406572
Name:VLIEG, MARIBETH
Entity type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:VLIEG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO. BOX 15585
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-746-9000
Mailing Address - Fax:775-746-9004
Practice Address - Street 1:6000 STONERIDGE MALL RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3209
Practice Address - Country:US
Practice Address - Phone:925-467-2149
Practice Address - Fax:925-467-3146
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11097183500000X
CA45668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist