Healthcare Provider Details

I. General information

NPI: 1326170044
Provider Name (Legal Business Name): MARIA ISABEL OLMEDA RG PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A3 URB SANTA MARTA CALL BOX 5000 SUITE 77
SAN GERMAN PR
00683-4402
US

IV. Provider business mailing address

A3 URB SANTA MARTA CALL BOX 5000 SUITE 77
SAN GERMAN PR
00683-4402
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-2058
  • Fax: 787-892-2058
Mailing address:
  • Phone: 787-892-2058
  • Fax: 787-892-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1884
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: