Provider Demographics
NPI:1245253616
Name:MARIBEL VEGA RIOS
Entity type:Organization
Organization Name:MARIBEL VEGA RIOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-763-1059
Mailing Address - Street 1:COND GARDEN CENTER #1 2
Mailing Address - Street 2:UNIVERSITY GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4853
Mailing Address - Country:US
Mailing Address - Phone:787-763-1059
Mailing Address - Fax:787-763-1074
Practice Address - Street 1:COND GARDEN CEN #1 2
Practice Address - Street 2:UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4853
Practice Address - Country:US
Practice Address - Phone:787-763-1059
Practice Address - Fax:787-763-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
PR09-F-18233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4017869OtherNABP
PR4017869OtherNABP