Healthcare Provider Details

I. General information

NPI: 1982820007
Provider Name (Legal Business Name): BRENDA ROSA OQUENDO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MENDEZ VIGO 269
DORADO PR
00646
US

IV. Provider business mailing address

#52 CALLE PRINCESA ESTANCIA DE LA FUENTE
TOA ALTA PR
00953-3608
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-1155
  • Fax: 787-796-8747
Mailing address:
  • Phone: 787-251-5761
  • Fax: 787-796-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4063
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: