Healthcare Provider Details

I. General information

NPI: 1689683088
Provider Name (Legal Business Name): HERIBERTO SUAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/15/2021
Certification Date: 10/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 CARR 2, INT. CALLE MORALES
BAYAMON PR
00961
US

IV. Provider business mailing address

119 CALLE TANAMA URB BRISAS DEL RIO
MOROVIS PR
00687-3953
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-2850
  • Fax:
Mailing address:
  • Phone: 787-328-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6928
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2796
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: