Provider Demographics
NPI:1548554116
Name:VICENTY, YANEILY MARI
Entity type:Individual
Prefix:MS
First Name:YANEILY
Middle Name:MARI
Last Name:VICENTY
Suffix:
Gender:F
Credentials:
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 953
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0953
Mailing Address - Country:US
Mailing Address - Phone:787-647-3948
Mailing Address - Fax:
Practice Address - Street 1:PALMAR DORADO NORTE 32000 CALLE REAL
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-0953
Practice Address - Country:US
Practice Address - Phone:787-647-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist