Provider Demographics
NPI:1346534096
Name:COLLAZO, MONICA (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 4078
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9636
Mailing Address - Country:US
Mailing Address - Phone:787-235-6219
Mailing Address - Fax:
Practice Address - Street 1:379 AVE LOS PATRIOTAS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2309
Practice Address - Country:US
Practice Address - Phone:787-897-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist