Provider Demographics
NPI:1033320189
Name:VAZQUEZ, NELSON G (PHARM D)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:G
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13218 SW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3119
Mailing Address - Country:US
Mailing Address - Phone:305-829-8178
Mailing Address - Fax:
Practice Address - Street 1:13218 SW 44TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3119
Practice Address - Country:US
Practice Address - Phone:305-829-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist