Provider Demographics
NPI:1700188687
Name:VESAGAS, KARINA POBRE (RPH)
Entity Type:Individual
Prefix:MS
First Name:KARINA
Middle Name:POBRE
Last Name:VESAGAS
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 1:3003 OLD ALABAMA RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8594
Mailing Address - Country:US
Mailing Address - Phone:678-566-3284
Mailing Address - Fax:
Practice Address - Street 1:3003 OLD ALABAMA RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8594
Practice Address - Country:US
Practice Address - Phone:678-566-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-25
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11077183500000X
GA022461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA022461OtherGEORGIA BOARD OF PHARMACY