Healthcare Provider Details

I. General information

NPI: 1053513291
Provider Name (Legal Business Name): ELSIE LIDIA PAGAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 CALLE BALDORIOTY N
AIBONITO PR
00705-3218
US

IV. Provider business mailing address

PO BOX 1077
AIBONITO PR
00705-1077
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-4887
  • Fax: 787-735-4887
Mailing address:
  • Phone: 787-735-6533
  • Fax: 787-735-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2722
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: