Provider Demographics
NPI:1548544703
Name:VASQUEZ, MARIA ELENA (PHARMD, CDE RPH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PHARMD, CDE RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 257853
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-8637
Mailing Address - Country:US
Mailing Address - Phone:866-352-5305
Mailing Address - Fax:
Practice Address - Street 1:1600 MCCONNOR PKWY
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-6801
Practice Address - Country:US
Practice Address - Phone:866-352-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290217183500000X
OR15822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist