Provider Demographics
NPI:1205388972
Name:BUSQUETS, IRAIDA
Entity Type:Individual
Prefix:
First Name:IRAIDA
Middle Name:
Last Name:BUSQUETS
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:PR2 KM 2.2
Mailing Address - Street 2:KENNEDY DRIVE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-522-3601
Mailing Address - Fax:
Practice Address - Street 1:PR2 KM 2.2
Practice Address - Street 2:AVE MARGINAL JOHN F KENNEDY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-522-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR03625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist