Provider Demographics
NPI:1255943577
Name:VUGHOSI, YVONNE ESIDIE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:ESIDIE
Last Name:VUGHOSI
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 1:720 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1800
Mailing Address - Country:US
Mailing Address - Phone:207-723-9850
Mailing Address - Fax:
Practice Address - Street 1:720 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1800
Practice Address - Country:US
Practice Address - Phone:207-723-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR69682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPR69682OtherPHARMACIST