Provider Demographics
NPI:1326374752
Name:COLON, PEDRO SR (PT PHARMACY TECHICIA)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:COLON
Suffix:SR
Gender:M
Credentials:PT PHARMACY TECHICIA
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 862
Mailing Address - Street 2:AVE EL JIBARO
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-714-0410
Mailing Address - Fax:787-714-0410
Practice Address - Street 1:AVE EL JIBARO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-714-0410
Practice Address - Fax:787-714-0410
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00726183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician