Provider Demographics
NPI:1932352804
Name:VAZQUEZ, ROBERTO L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:L
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 HARGRAVE ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-1644
Mailing Address - Country:US
Mailing Address - Phone:310-677-0168
Mailing Address - Fax:310-677-0168
Practice Address - Street 1:257 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4130
Practice Address - Country:US
Practice Address - Phone:626-449-0099
Practice Address - Fax:626-449-7666
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH29680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist