Provider Demographics
NPI:1043665797
Name:CARVAJAL-SIERRA, YEZLIE A (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:YEZLIE
Middle Name:A
Last Name:CARVAJAL-SIERRA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-0887
Mailing Address - Country:US
Mailing Address - Phone:787-469-6241
Mailing Address - Fax:
Practice Address - Street 1:CARR 156 R-790 KM 8.4
Practice Address - Street 2:BO MULITAS ALVELO
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-469-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9663183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR165448OtherHEALTH DEPARTMENT