Provider Demographics
NPI:1043504616
Name:SUAREZ, JESSIE ASLYN
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:ASLYN
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 BULEVAR LAS AMERICAS
Mailing Address - Street 2:URB. VILLAS DE LAUREL II
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2244
Mailing Address - Country:US
Mailing Address - Phone:787-685-4886
Mailing Address - Fax:787-848-1281
Practice Address - Street 1:2023 AVE LAS AMERICAS
Practice Address - Street 2:WALGREENS STORE 199
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-843-5777
Practice Address - Fax:787-843-3547
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist