Provider Demographics
NPI:1003035700
Name:BLASINI, IVELISSE (RPH)
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:BLASINI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STATE 149 & STATE 584
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-260-1544
Mailing Address - Fax:787-260-1544
Practice Address - Street 1:STATE 149 & STATE 584
Practice Address - Street 2:PLAZA JUANA DIAZ CARR.14 INR.CARR, 584
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-260-1544
Practice Address - Fax:787-260-1544
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist