Healthcare Provider Details

I. General information

NPI: 1841324704
Provider Name (Legal Business Name): WILSON ROVIRA R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAMOS ANTONINI STREET #57 OESTE
MAYAGUEZ PR
00681
US

IV. Provider business mailing address

RAMOS ANTONNI AVE. 57 WEST
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-2395
  • Fax:
Mailing address:
  • Phone: 787-832-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2369
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: