=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588710354
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRIA M LUGO RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ROAD 119 KM 9.0
-----------------------------------------------------
City | CAMUY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-820-2148
-----------------------------------------------------
Fax | 787-820-8181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 6 BOX 10400
-----------------------------------------------------
City | CAMUY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-820-2148
-----------------------------------------------------
Fax | 787-820-8181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 4365
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------