Provider Demographics
NPI:1053852723
Name:TORRES, AWILDA (PH)
Entity Type:Individual
Prefix:
First Name:AWILDA
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:PH
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 349 SAB
Mailing Address - Street 2:1
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-873-3960
Mailing Address - Fax:787-873-6868
Practice Address - Street 1:30 AG MARTINEZ
Practice Address - Street 2:FARMACIA IRIZARRY
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-873-3960
Practice Address - Fax:787-873-6868
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist