Provider Demographics
NPI:1932820081
Name:VAZQUEZ COSTAS, PAOLA ALEXANDRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:ALEXANDRA
Last Name:VAZQUEZ COSTAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 RUBY RED PL
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8376
Mailing Address - Country:US
Mailing Address - Phone:407-550-9007
Mailing Address - Fax:689-216-3916
Practice Address - Street 1:204 RUBY RED PL
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8376
Practice Address - Country:US
Practice Address - Phone:407-550-9007
Practice Address - Fax:689-216-3916
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist