Provider Demographics
NPI:1831414267
Name:VEGUILLA, EDWIN M
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:M
Last Name:VEGUILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SAN ANTONIO E-10 4ST.
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-509-7499
Mailing Address - Fax:787-893-2440
Practice Address - Street 1:E-10 4ST.
Practice Address - Street 2:URB. SAN ANTONIO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-509-7499
Practice Address - Fax:787-893-2440
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist