Healthcare Provider Details

I. General information

NPI: 1679604086
Provider Name (Legal Business Name): MRS. YOLANDA IRIZARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FARMAUA SAN FELIPE CARR 129 15 BO BAYANEY
HATILLO PR
00659
US

IV. Provider business mailing address

PO BOX 49001 PMB 113
HATILLO PR
00659
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-6378
  • Fax: 787-898-6378
Mailing address:
  • Phone: 787-201-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number002551
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: