=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467118141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACIELA VICTORIA LAUREANO-RUIZ PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2021
-----------------------------------------------------
Last Update Date | 03/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2016 AVE BORINQUEN
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00915-3823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-919-6931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 418 CALLE TULANE
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00693-3608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-585-4731
-----------------------------------------------------
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 | 6911
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------