=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073354676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIKA MABELLIANN BLANCO-ORTIZ PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2024
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | C1 CALLE PARKSIDE 4
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00968-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-761-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | F26 CALLE CERRO PENUELAS
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987-8013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-761-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8088
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------