Healthcare Provider Details

I. General information

NPI: 1407933617
Provider Name (Legal Business Name): LOURDES AIXA COLON PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 KM 15 0 BAYANEY
HATILLO PR
00659
US

IV. Provider business mailing address

BOX 78
ANGELES PR
00611
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-6378
  • Fax: 787-898-6378
Mailing address:
  • Phone: 787-898-6378
  • Fax: 787-898-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3767
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: