=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306544911
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLLE YARIE PEREZ AYALA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2023
-----------------------------------------------------
Last Update Date | 02/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URBANIZACION BRISAS DEL CAMPANERO 2 293 CALLE 7 E10
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00949-4871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 797-786-6306
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB BRISAS DEL CAMPANERO II 293 CALLE AQUAMARINA E10
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-579-9026
-----------------------------------------------------
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 | 7077
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------