Provider Demographics
NPI:1144931486
Name:VAZQUEZ, AXEL MANUEL (RPH)
Entity type:Individual
Prefix:
First Name:AXEL
Middle Name:MANUEL
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 8212A
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-8807
Mailing Address - Country:US
Mailing Address - Phone:787-217-0298
Mailing Address - Fax:
Practice Address - Street 1:500 CARRETERA 1 URB. ALTOS DE LA FUENTE CAGUAS-DF-02922
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-286-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist