Healthcare Provider Details

I. General information

NPI: 1114793049
Provider Name (Legal Business Name): KLOE ANGELIC CUEVAS COLLAZO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/03/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 AVE AMERICO MIRANDA
SAN JUAN PR
00921-2842
US

IV. Provider business mailing address

TIGRIS 1614 EL PARAISO
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-7908
  • Fax:
Mailing address:
  • Phone: 787-587-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number8117
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: