Healthcare Provider Details

I. General information

NPI: 1982414082
Provider Name (Legal Business Name): EYDIE MARALYZ GONZALEZ DEL OLMO PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CALLE GEORGETTI
BARCELONETA PR
00617-2712
US

IV. Provider business mailing address

HC 1 BOX 2868
SABANA HOYOS PR
00688-8842
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-3474
  • Fax:
Mailing address:
  • Phone: 787-462-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number011191
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier011191
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPHARAMCY TECHNICIAN LICENSE
# 2
Identifier00200146
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerREGISTRO DE TECNICO DE FARMACIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: