=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891071692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWIN DELGADO RIVERA R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2011
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 STATE ROAD 1 ALTOS DE LA FUENTE
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-286-8242
-----------------------------------------------------
Fax | 787-286-8249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 1526
-----------------------------------------------------
City | JUNCOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-202-5866
-----------------------------------------------------
Fax | 787-286-8249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 4419
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------