Provider Demographics
NPI:1235424961
Name:FERNANDEZ SOSA, AIDA (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:
Last Name:FERNANDEZ SOSA
Suffix:
Gender:F
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:VIA DEL PARQUE L1
Mailing Address - Street 2:URBANIZACION LA VISTA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4570
Mailing Address - Country:US
Mailing Address - Phone:787-769-9804
Mailing Address - Fax:
Practice Address - Street 1:150 CARR 857
Practice Address - Street 2:& STATE RD 3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-2277
Practice Address - Country:US
Practice Address - Phone:787-701-0808
Practice Address - Fax:787-701-0836
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist