1407123151 NPI number — ELLIS SHAMYR ARAGONES PHARMACIST

Table of content: ELLIS SHAMYR ARAGONES PHARMACIST (NPI 1407123151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407123151 NPI number — ELLIS SHAMYR ARAGONES PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARAGONES
Provider First Name:
ELLIS
Provider Middle Name:
SHAMYR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARAGONES
Provider Other First Name:
ELLIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMACYST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407123151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE TORCAZ URBANIZACION HACIENDA PALOMA
Provider Second Line Business Mailing Address:
#81
Provider Business Mailing Address City Name:
LUQUILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00773-0773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-435-9318
Provider Business Mailing Address Fax Number:
787-860-1614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE MARGINAL
Provider Second Line Business Practice Location Address:
4203
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-0738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-860-1603
Provider Business Practice Location Address Fax Number:
787-860-1614
Provider Enumeration Date:
11/23/2011

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: 183500000X , with the licence number:  5147 , 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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