Healthcare Provider Details

I. General information

NPI: 1205389202
Provider Name (Legal Business Name): HENDRIKA IVELISSE ALVAREZ PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CALLE TABONUCO CITY PARADISE
BARCELONETA PR
00617-2743
US

IV. Provider business mailing address

26 CALLE TABONUCO CITY PARADISE
BARCELONETA PR
00617
US

V. Phone/Fax

Practice location:
  • Phone: 787-414-4745
  • Fax:
Mailing address:
  • Phone: 787-414-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number011474
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: