Provider Demographics
NPI:1093000846
Name:GUTIERREZ, RAFAEL A (RPH)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR #2 KM 129.7
Mailing Address - Street 2:INT CARR 111 BO. VICTORIA
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4007
Mailing Address - Country:US
Mailing Address - Phone:787-882-8044
Mailing Address - Fax:787-882-0655
Practice Address - Street 1:DBA: WALGREENS 00177 CARR 2 KM 129.7
Practice Address - Street 2:INT CARR 111 BO. VICTORIA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-4005
Practice Address - Country:US
Practice Address - Phone:787-882-8044
Practice Address - Fax:787-882-0655
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist