Provider Demographics
NPI:1346391919
Name:JORGE L COLON COLON
Entity Type:Organization
Organization Name:JORGE L COLON COLON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMCIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-265-5910
Mailing Address - Street 1:PO BOX 1851
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1851
Mailing Address - Country:US
Mailing Address - Phone:787-265-5910
Mailing Address - Fax:787-265-5910
Practice Address - Street 1:CARR. 64 ( OLD341) KM 3.4 BO MANI
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-5910
Practice Address - Fax:787-265-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-20293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1266550001Medicare ID - Type Unspecified