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General NPI Number Information
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NPI Number | 1144431578
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Entity Type | Individual
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Provider Name | LISMERY GORDILLO 3976585
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CARR 132 KM 22.1
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City | PONCE
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State | PR
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Zip | 00728
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Country | US
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Telephone | 787-290-1953
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Fax |
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Provider Business Mailing Address
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Address Line | #100 CONDOMINIO LA CEIBA APARTAMENTO 910
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-449-4232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5971
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License Number State | PR
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