1326374752 NPI number — MR. PEDRO COLON SR. PT PHARMACY TECHICIA

Table of content: MR. PEDRO COLON SR. PT PHARMACY TECHICIA (NPI 1326374752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326374752 NPI number — MR. PEDRO COLON SR. PT PHARMACY TECHICIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON
Provider First Name:
PEDRO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PT PHARMACY TECHICIA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326374752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 862
Provider Second Line Business Mailing Address:
AVE EL JIBARO
Provider Business Mailing Address City Name:
CIDRA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-714-0410
Provider Business Mailing Address Fax Number:
787-714-0410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE EL JIBARO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIDRA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-714-0410
Provider Business Practice Location Address Fax Number:
787-714-0410
Provider Enumeration Date:
10/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  00726 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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