Provider Demographics
NPI:1255936555
Name:EBEO, VIVIAN OZARAGA (RPH)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:OZARAGA
Last Name:EBEO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHESTNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-7456
Mailing Address - Country:US
Mailing Address - Phone:423-753-5240
Mailing Address - Fax:
Practice Address - Street 1:2120 S ROAN ST STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7675
Practice Address - Country:US
Practice Address - Phone:423-979-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist