Healthcare Provider Details

I. General information

NPI: 1982187852
Provider Name (Legal Business Name): LOURDES ISABEL DELASOTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALGREENS 11430 70 AVE RIO HONDO
BAYAMON PR
00961
US

IV. Provider business mailing address

WALGREENS 11430 70 AVE RIO HONDO
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-8436
  • Fax:
Mailing address:
  • Phone: 787-795-8436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number453
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: