Provider Demographics
NPI:1164967592
Name:COLON, JORGE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 1851
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00676
Mailing Address - Country:UM
Mailing Address - Phone:787-224-0217
Mailing Address - Fax:787-265-5910
Practice Address - Street 1:CARR. 64 KM 3.4 BO. MANI
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00681
Practice Address - Country:UM
Practice Address - Phone:787-265-5910
Practice Address - Fax:787-265-5910
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1346391919OtherPHARMACY