Provider Demographics
NPI:1225384134
Name:DELGADO, JULISSA (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:JULISSA
Middle Name:
Last Name:DELGADO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 AVE PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00965-5607
Mailing Address - Country:US
Mailing Address - Phone:787-771-1644
Mailing Address - Fax:787-771-1649
Practice Address - Street 1:25 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965-5607
Practice Address - Country:US
Practice Address - Phone:787-771-1644
Practice Address - Fax:787-771-1649
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist