=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750448288
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALBERT ALICEA RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | #129 LUIS MUNOZ RIVERA
-----------------------------------------------------
City | GUAYANILLA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00656-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-835-3525
-----------------------------------------------------
Fax | 787-835-1125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | K-5 RIVERSIDE
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-892-6763
-----------------------------------------------------
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 | 3673
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------