Provider Demographics
NPI:1275745945
Name:COLON, WIGNELIA
Entity Type:Individual
Prefix:
First Name:WIGNELIA
Middle Name:
Last Name:COLON
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:D24 CALLE 14
Mailing Address - Street 2:URB. MEDINA
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3807
Mailing Address - Country:US
Mailing Address - Phone:787-223-5942
Mailing Address - Fax:787-872-2145
Practice Address - Street 1:1 - 350 G NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-1127
Practice Address - Country:US
Practice Address - Phone:787-872-1930
Practice Address - Fax:787-872-2145
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4083183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician