Provider Demographics
NPI:1104003391
Name:DE JESUS, IRIS MARANGELI (RPH)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:MARANGELI
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 CALLE NAVARRA
Mailing Address - Street 2:LA RAMBLA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4043
Mailing Address - Country:US
Mailing Address - Phone:787-848-7089
Mailing Address - Fax:787-651-0486
Practice Address - Street 1:#14 STATE ROAD
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-651-0484
Practice Address - Fax:787-651-0486
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist