Provider Demographics
NPI:1235276841
Name:SEGARRA, EDNA
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:SEGARRA
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:APT 702 COND AVENTURA
Mailing Address - Street 2:ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-755-4977
Mailing Address - Fax:787-256-0172
Practice Address - Street 1:84 CALLE EUSEBIO ITURRINO
Practice Address - Street 2:URB DEL PILAR
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3204
Practice Address - Country:US
Practice Address - Phone:787-256-3592
Practice Address - Fax:787-256-0172
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist