Healthcare Provider Details

I. General information

NPI: 1639225139
Provider Name (Legal Business Name): MANUEL ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 PONCE BY PASS
PONCE PR
00717
US

IV. Provider business mailing address

662 CALLE LADY DI URB. LOS ALMENDROS
PONCE PR
00716-3534
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8686
  • Fax: 787-843-8999
Mailing address:
  • Phone: 787-848-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4011
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: