Healthcare Provider Details

I. General information

NPI: 1285204321
Provider Name (Legal Business Name): ROSEANNE COLLAZO NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE SONIA AJ 16
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 142872
ARECIBO PR
00614-2872
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-5487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6831
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: