Provider Demographics
NPI:1326273616
Name:PAGAN RIVERA, LUIS DANIEL (RPH)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:DANIEL
Last Name:PAGAN RIVERA
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:URBANIZACION ESTANCIAS DE CERRO GORDO, PLAZA LIAN # 36
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-316-8164
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION ESTANCIAS DE CERRO GORDO, PLAZA LIAN # 36
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-316-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist