Healthcare Provider Details

I. General information

NPI: 1346619855
Provider Name (Legal Business Name): AMARILYS TIBURCIO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 CALLE MARGINAL
FAJARDO PR
00738
US

IV. Provider business mailing address

F33 CALLE MARGINAL SANTA ISIDRA 3
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-1603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6302
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: