Provider Demographics
NPI:1164688404
Name:PAGAN, VILMA A (PH)
Entity type:Individual
Prefix:
First Name:VILMA
Middle Name:A
Last Name:PAGAN
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VALLE REAL 1518
Mailing Address - Street 2:EMPERATRIZ SUITE
Mailing Address - City:PONCE
Mailing Address - State:RI
Mailing Address - Zip Code:00717-0500
Mailing Address - Country:US
Mailing Address - Phone:787-840-2326
Mailing Address - Fax:787-260-7702
Practice Address - Street 1:HC 1 BOX 4046
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9701
Practice Address - Country:US
Practice Address - Phone:787-837-5445
Practice Address - Fax:787-260-7702
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3443Other2008-051060 PR REGISTER PH