Provider Demographics
NPI:1275080053
Name:MARIN ROBERTO, TATIANA (PHARMACY TECH)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:MARIN ROBERTO
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D49 CALLE YAGRUMO
Mailing Address - Street 2:VISTA VERDE
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718
Mailing Address - Country:US
Mailing Address - Phone:787-668-4283
Mailing Address - Fax:
Practice Address - Street 1:104 CALLE FONT MARTELO E STE 1
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3946
Practice Address - Country:US
Practice Address - Phone:787-850-9246
Practice Address - Fax:787-285-4095
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9610183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6015022OtherDRIVERS LICENSE