=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487786778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEDRO LUIS SOTO BS PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 CALLE RAMON DE JESUS
-----------------------------------------------------
City | LARES
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00669-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-897-2464
-----------------------------------------------------
Fax | 787-897-3231
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB.VILLA SERAL A53
-----------------------------------------------------
City | LARES
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00669-3010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-897-6336
-----------------------------------------------------
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 | 1985
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------