Provider Demographics
NPI:1750446092
Name:BLANCA L. VEGA ALVARADO
Entity type:Organization
Organization Name:BLANCA L. VEGA ALVARADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-862-2244
Mailing Address - Street 1:HC 2 BOX 5778
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-9721
Mailing Address - Country:US
Mailing Address - Phone:787-862-2244
Mailing Address - Fax:787-862-2244
Practice Address - Street 1:CARR 633 KM 4 7
Practice Address - Street 2:BO BARAHONA
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687
Practice Address - Country:US
Practice Address - Phone:787-862-2244
Practice Address - Fax:787-862-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-01283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-16665OtherNABP