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General NPI Number Information
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NPI Number | 1710414651
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Entity Type | Individual
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Provider Name | ALTAGRACIA DEL CARMEN DE LA CRUZ TECNICO DE FARMACIA
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Gender | Female
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 404 AVE BARBOSA ESQ CALLE SICILIA CDT DR KOPPISCH
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City | RIO PIEDRAS
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-294-0076
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Fax | 787-294-0076
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Provider Business Mailing Address
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Address Line | 419 AVE PONCE DE LEON ESQ CALLE JUAN DUARTE METROPOLIS APTS APT 710
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City | SAN JUAN
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State | PR
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Zip | 00917
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Country | US
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Telephone | 787-989-4416
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Fax |
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 011533
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License Number State | PR
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