Provider Demographics
NPI:1730784349
Name:VAZQUEZ, JUAN C (RPH)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:VAZQUEZ
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 1:4650 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2007
Mailing Address - Country:US
Mailing Address - Phone:954-426-5224
Mailing Address - Fax:954-426-5591
Practice Address - Street 1:4650 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2007
Practice Address - Country:US
Practice Address - Phone:954-426-5224
Practice Address - Fax:954-426-5591
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS00339613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy