Healthcare Provider Details

I. General information

NPI: 1003944372
Provider Name (Legal Business Name): JOSEPH ROQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CALLE MUNOZ RIVERA
NAGUABO PR
00718
US

IV. Provider business mailing address

19 CALLE MUNOZ RIVERA
NAGUABO PR
00718
US

V. Phone/Fax

Practice location:
  • Phone: 787-874-2134
  • Fax:
Mailing address:
  • Phone: 787-874-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: