Provider Demographics
NPI:1114793049
Name:CUEVAS COLLAZO, KLOE ANGELIC (PHARMD)
Entity Type:Individual
Prefix:
First Name:KLOE
Middle Name:ANGELIC
Last Name:CUEVAS COLLAZO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TIGRIS 1614 EL PARAISO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-587-3101
Mailing Address - Fax:
Practice Address - Street 1:1008 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2842
Practice Address - Country:US
Practice Address - Phone:787-758-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR81171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist