Provider Demographics
NPI:1326686106
Name:OLIVO, AIDA MIRTA
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:MIRTA
Last Name:OLIVO
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:HC 57 BOX 15602
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE PROGRESO 258
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist