Provider Demographics
NPI:1265652523
Name:RAMIREZ, IVAN (RPH)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0088
Mailing Address - Country:US
Mailing Address - Phone:787-318-2485
Mailing Address - Fax:
Practice Address - Street 1:A1 CALLE MANUEL G TAVAREZ
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3342
Practice Address - Country:US
Practice Address - Phone:787-318-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist