Provider Demographics
NPI:1700952298
Name:VEGA, WAYNE J (RPH)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:J
Last Name:VEGA
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 1:33215 BLUE FIN DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1416
Mailing Address - Country:US
Mailing Address - Phone:949-661-0817
Mailing Address - Fax:949-661-6430
Practice Address - Street 1:33215 BLUE FIN DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1416
Practice Address - Country:US
Practice Address - Phone:949-661-0817
Practice Address - Fax:949-661-6430
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist