Provider Demographics
NPI:1063447233
Name:COLON-LASSALA, ELDA E (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ELDA
Middle Name:E
Last Name:COLON-LASSALA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4163
Mailing Address - Street 2:
Mailing Address - City:AQUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4163
Mailing Address - Country:US
Mailing Address - Phone:787-431-1384
Mailing Address - Fax:787-265-3685
Practice Address - Street 1:1050 AVE. RAMON ARBONA
Practice Address - Street 2:BARRIO SABALOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-2718
Practice Address - Fax:787-265-3685
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist