Provider Demographics
NPI:1003962028
Name:COLON, LUIS G (RPH)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:G
Last Name:COLON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:SA12 PASEO DE LAS FLORES
Mailing Address - Street 2:URBANIZACION PRIMAVERA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6075
Mailing Address - Country:US
Mailing Address - Phone:787-293-2669
Mailing Address - Fax:
Practice Address - Street 1:K627 AVE PONTEZUELA
Practice Address - Street 2:URBANIZACION VISTAMAR
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1402
Practice Address - Country:US
Practice Address - Phone:787-768-6637
Practice Address - Fax:787-762-0780
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist