Provider Demographics
NPI:1538595251
Name:REYES, VIDAL A (RPH)
Entity type:Individual
Prefix:MR
First Name:VIDAL
Middle Name:A
Last Name:REYES
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 1:142 CALLE REINITA
Mailing Address - Street 2:URB PASEO PALMA REAL
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-3138
Mailing Address - Country:US
Mailing Address - Phone:787-647-1588
Mailing Address - Fax:
Practice Address - Street 1:LAS CATALINAS MALL
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5200
Practice Address - Country:US
Practice Address - Phone:787-745-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist