Healthcare Provider Details

I. General information

NPI: 1194918532
Provider Name (Legal Business Name): CDT EULALIA KUILAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 869 BO PALMAS
CATANO PR
00963-0428
US

IV. Provider business mailing address

P.O BOX 428 C.DT EULALIA KUILAN
CATANO PR
00963-0428
US

V. Phone/Fax

Practice location:
  • Phone: 787-788-1995
  • Fax:
Mailing address:
  • Phone: 787-788-1995
  • Fax: 787-275-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number09F0946
License Number StatePR

VIII. Authorized Official

Name: NORMA VAZQUEZ BADILLO
Title or Position: PHARMACY REGENT
Credential: LIC 1855 OF P.R.
Phone: 787-788-6089