Healthcare Provider Details

I. General information

NPI: 1376129452
Provider Name (Legal Business Name): DARLENE COLON CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C1 CALLE PARKSIDE 4
GUAYNABO PR
00968-3305
US

IV. Provider business mailing address

PO BOX 2113
GUAYNABO PR
00970-2113
US

V. Phone/Fax

Practice location:
  • Phone: 787-792-0780
  • Fax:
Mailing address:
  • Phone: 939-401-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number11519
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: