Healthcare Provider Details

I. General information

NPI: 1326374752
Provider Name (Legal Business Name): PEDRO COLON SR. PT PHARMACY TECHICIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE EL JIBARO
CIDRA PR
00739
US

IV. Provider business mailing address

PO BOX 862 AVE EL JIBARO
CIDRA PR
00739
US

V. Phone/Fax

Practice location:
  • Phone: 787-714-0410
  • Fax: 787-714-0410
Mailing address:
  • Phone: 787-714-0410
  • Fax: 787-714-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number00726
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: