Provider Demographics
NPI:1083760862
Name:DE GUZMAN, MERVIN (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MERVIN
Middle Name:
Last Name:DE GUZMAN
Suffix:
Gender:M
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:S20 CALLE R
Mailing Address - Street 2:MONTE BRISAS
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3241
Mailing Address - Country:US
Mailing Address - Phone:787-885-3010
Mailing Address - Fax:787-885-1595
Practice Address - Street 1:266 AVE LAURO PINERO
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2706
Practice Address - Country:US
Practice Address - Phone:787-885-3010
Practice Address - Fax:787-885-1595
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3383183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician