Healthcare Provider Details

I. General information

NPI: 1265440259
Provider Name (Legal Business Name): ANDRES COLON PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO CAMPAMENTO 500 CARR 149 SUITE 01
CIALES PR
00638-9661
US

IV. Provider business mailing address

500 CARR 149 STE 1
CIALES PR
00638-9661
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-3105
  • Fax: 787-871-3122
Mailing address:
  • Phone: 787-871-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4758
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: