Provider Demographics
NPI:1083907786
Name:NIEVES, NIRCA JETZENIA (RPH, PHD)
Entity Type:Individual
Prefix:
First Name:NIRCA
Middle Name:JETZENIA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZA LAUREL
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3273
Mailing Address - Country:US
Mailing Address - Phone:787-269-4200
Mailing Address - Fax:787-269-4270
Practice Address - Street 1:PLAZA LAUREL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3273
Practice Address - Country:US
Practice Address - Phone:787-269-4200
Practice Address - Fax:787-269-4270
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist