Provider Demographics
NPI:1134836661
Name:VAZQUEZ VARGAS, MAURICIO (PHARMD)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:VAZQUEZ VARGAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4525
Mailing Address - Country:US
Mailing Address - Phone:419-370-8431
Mailing Address - Fax:
Practice Address - Street 1:3201 SEYMOUR HWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-1716
Practice Address - Country:US
Practice Address - Phone:940-766-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist