Healthcare Provider Details

I. General information

NPI: 1598742256
Provider Name (Legal Business Name): NILDA GHIGLIOTTY PH. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 CALLE RAMOS ANTONINI EL TUQUE
PONCE PR
00728-4806
US

IV. Provider business mailing address

A 13 VILLAS DEL SAGRADO CORAZON
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2805
  • Fax: 787-841-5551
Mailing address:
  • Phone: 787-842-3889
  • Fax: 787-841-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2869
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: