Healthcare Provider Details

I. General information

NPI: 1669508388
Provider Name (Legal Business Name): IZETTE M. DEL MORAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #3 KM 24.5 PLAZA RIO GRANDE BO. GUZMAN ABAJO
RIO GRANDE PR
00745
US

IV. Provider business mailing address

5244 EDGEWOOD CT STE 2
JACKSONVILLE FL
32254-3601
US

V. Phone/Fax

Practice location:
  • Phone: 787-657-3555
  • Fax:
Mailing address:
  • Phone: 800-218-8587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3972
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS26730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: