Healthcare Provider Details

I. General information

NPI: 1689122244
Provider Name (Legal Business Name): JENNIFER CONCEPCION CARDONA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 2 KILOMETRO 45.8 PLAZA MONTE REAL
MANATI PR
00674
US

IV. Provider business mailing address

79 CALLE FLAMBOYAN URB LOS LLANOS
CIALES PR
00638-9676
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-0007
  • Fax: 787-854-6705
Mailing address:
  • Phone: 787-240-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6316
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: