Provider Demographics
NPI:1679112817
Name:VAZQUEZ, ALEXANDRA (PHARM D)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:VAZQUEZ-ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:CARR 172 KM 5.6 BO CANABONCITO
Mailing Address - Street 2:
Mailing Address - City:CAGUAS PR
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-961-6030
Mailing Address - Fax:
Practice Address - Street 1:CARR 172 KM 5.6 BO CANABONCITO
Practice Address - Street 2:
Practice Address - City:CAGUAS PR
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-961-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist