Provider Demographics
NPI:1457714750
Name:SANTIAGO VAZQUEZ, ISRAEL (PHARMD, BCMTMS)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:SANTIAGO VAZQUEZ
Suffix:
Gender:M
Credentials:PHARMD, BCMTMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13441 PALMERA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3507
Mailing Address - Country:US
Mailing Address - Phone:813-499-8759
Mailing Address - Fax:
Practice Address - Street 1:7351 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4953
Practice Address - Country:US
Practice Address - Phone:813-884-2506
Practice Address - Fax:813-885-1493
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54756183500000X
PR6313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist