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General NPI Number Information
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NPI Number | 1245352129
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Entity Type | Individual
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Provider Name | ILIA CORREA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ALMACEN DE FARMACIA, CENTRO MEDICO
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City | SAN JUAN
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State | PR
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Zip | 00922-2129
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Country | US
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Telephone | 787-777-3535
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Fax | 787-777-2799
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Provider Business Mailing Address
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Address Line | ACADIA ST #N56A, PARK GARDENS
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-755-3039
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Fax | 787-777-2799
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1779
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License Number State | PR
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