Healthcare Provider Details

I. General information

NPI: 1093659435
Provider Name (Legal Business Name): ANDREA AGOSTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 685 KM 1.9 BO TIERRAS NUEVAS
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1019
MANATI PR
00674-1019
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-4805
  • Fax:
Mailing address:
  • Phone: 787-854-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8484
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: