Provider Demographics
NPI:1255468401
Name:PURCELL, INDIRA (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:INDIRA
Middle Name:
Last Name:PURCELL
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 1:459 RIO YAGUEZ MONTE CASINO HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-251-2698
Mailing Address - Fax:
Practice Address - Street 1:AVE. LOMAS VERDES, EDIF, UNIVERSIDAD PHOENIX
Practice Address - Street 2:CARRETERA 177, KM. 2.0
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00595
Practice Address - Country:US
Practice Address - Phone:787-272-4998
Practice Address - Fax:787-272-4969
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4225OtherPHARMACIST