Basic Information
| Provider Information | |||||||||
| NPI: | 1619517802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERGARA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ANGEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | FARMACIAS CARIDAD PLAZA DEL CARMEN MALL | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877431273 | ||||||||
| FaxNumber: | 7877435929 | ||||||||
| Practice Location | |||||||||
| Address1: | AVE PINO LOCAL 51 PLAZA DEL CARMEN MALL | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877431273 | ||||||||
| FaxNumber: | 7877435929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2020 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 4214 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.