Healthcare Provider Details

I. General information

NPI: 1487326153
Provider Name (Legal Business Name): JOHANA ROSA PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1484 AVE F D ROOSEVELT SUITE 19
SAN JUAN PR
00920-2732
US

IV. Provider business mailing address

1484 AVE. F. D. ROOSEVELT, SUITE 19
SAN JUAN PR
00920-2732
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-4510
  • Fax: 787-792-0831
Mailing address:
  • Phone: 787-783-4510
  • Fax: 787-792-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number14734
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: