Basic Information
| Provider Information | |||||||||
| NPI: | 1346881133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAGONOT | ||||||||
| FirstName: | VINCENT DOUGLAS | ||||||||
| MiddleName: | LUCERO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4821 BOYD DR | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956084915 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10535 HOSPITAL WAY | ||||||||
| Address2: | |||||||||
| City: | MATHER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956554200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168437000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2019 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 75799 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.