1770893794 NPI number — EIMER MALDONADO PHARMACY DOCTOR

Table of content: EIMER MALDONADO PHARMACY DOCTOR (NPI 1770893794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770893794 NPI number — EIMER MALDONADO PHARMACY DOCTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALDONADO
Provider First Name:
EIMER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACY DOCTOR
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:
1770893794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLALBA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00766-0102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-430-2867
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 150 KM 1 H5
Provider Second Line Business Practice Location Address:
BO CAMARONES SECTOR LOS ROBLES
Provider Business Practice Location Address City Name:
VILLALBA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-812-5980
Provider Business Practice Location Address Fax Number:
787-812-5966
Provider Enumeration Date:
10/08/2010

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: 1835P0018X , with the licence number:  5352 , 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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