Provider Demographics
NPI:1326170044
Name:OLMEDA, MARIA ISABEL (RG PH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ISABEL
Last Name:OLMEDA
Suffix:
Gender:F
Credentials:RG PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A3 URB SANTA MARTA
Mailing Address - Street 2:CALL BOX 5000 SUITE 77
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4402
Mailing Address - Country:US
Mailing Address - Phone:787-892-2058
Mailing Address - Fax:787-892-2058
Practice Address - Street 1:A3 URB SANTA MARTA
Practice Address - Street 2:CALL BOX 5000 SUITE 77
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4402
Practice Address - Country:US
Practice Address - Phone:787-892-2058
Practice Address - Fax:787-892-2058
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1884OtherPHARMACIST PR LICENCE