Provider Demographics
NPI:1093840548
Name:CRESPO, NYDIAN (PHARM TECH)
Entity Type:Individual
Prefix:
First Name:NYDIAN
Middle Name:
Last Name:CRESPO
Suffix:
Gender:F
Credentials:PHARM TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. SABANA HOYOS HC-83 BUZON 6673
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9710
Mailing Address - Country:US
Mailing Address - Phone:787-883-1838
Mailing Address - Fax:
Practice Address - Street 1:BO.SABANA HOYOS HC-83 BUZON 6673
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-9710
Practice Address - Country:US
Practice Address - Phone:787-883-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5072183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician