Healthcare Provider Details

I. General information

NPI: 1467187849
Provider Name (Legal Business Name): PAULA D VINA PHARMACY TECHNICIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H22 CALLE ARECA
BAYAMON PR
00956-4442
US

IV. Provider business mailing address

URB. CAMPO ALEGRE CALLE ARECA H-22
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-387-4331
  • Fax:
Mailing address:
  • Phone: 787-387-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number010802
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: