Provider Demographics
NPI:1134456544
Name:MARZAN, YADIRA M
Entity Type:Individual
Prefix:MISS
First Name:YADIRA
Middle Name:M
Last Name:MARZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 62
Mailing Address - Street 2:COOP. ROLLING HILLS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-235-8417
Mailing Address - Fax:
Practice Address - Street 1:C/TEGUCIGALPA ESQ. LIMA COOP. ROLLING HILLS
Practice Address - Street 2:SUITE 62
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-235-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7844183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician