Provider Demographics
NPI:1083370332
Name:FRED, RUTH DALIANA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:DALIANA
Last Name:FRED
Suffix:
Gender:F
Credentials:PHARM D
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 756
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0756
Mailing Address - Country:US
Mailing Address - Phone:787-887-2475
Mailing Address - Fax:787-888-1033
Practice Address - Street 1:CALLE PIMENTEL
Practice Address - Street 2:#17
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-2475
Practice Address - Fax:787-888-1033
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist