MEDICARE: ELDA E COLON-LASSALA PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2588	PR

General Provider Information

NPI Number	:	1063447233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELDA E COLON-LASSALA PHARMACIST

Provider Business Mailing Address
First Line	:	P.O. BOX 4163
Second Line	:
City	:	AQUADILLA
State	:	PR
Zip	:	00605-4163
Country	:	US
Telephone Number	:	787-431-1384
Fax Number	:	787-265-3685

Provider Business Practice Location Address
First Line	:	1050 AVE. RAMON ARBONA
Second Line	:	BARRIO SABALOS
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680
Country	:	US
Telephone Number	:	787-833-2718
Fax Number	:	787-265-3685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	04/26/2026

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