MEDICARE: LUZ M COLON R.PH.

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	2306	PR

General Provider Information

NPI Number	:	1376664482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ M COLON R.PH.

Provider Business Mailing Address
First Line	:	PMB 548 HC-1
Second Line	:	BOX 29030
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	787-272-3246
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 AVE BORINQUEN
Second Line	:	BARRIO OBRERO
City	:	SAN JUAN
State	:	PR
Zip	:	00915-4427
Country	:	US
Telephone Number	:	787-726-3350
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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