Healthcare Provider Details

I. General information

NPI: 1356726384
Provider Name (Legal Business Name): EVELYN COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 CALLE 65 INFANTERIA
ANASCO PR
00610-2921
US

IV. Provider business mailing address

67 CALLE 65 INFANTERIA
ANASCO PR
00610-2921
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-2545
  • Fax: 787-826-4022
Mailing address:
  • Phone: 787-826-2545
  • Fax: 787-826-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5069
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: