Provider Demographics
NPI:1346673357
Name:PAGAN, MILDRED
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:PAGAN
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:ST GUAYACAN S 28
Mailing Address - Street 2:URB STA ELENA
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-1437
Mailing Address - Country:US
Mailing Address - Phone:787-892-1500
Mailing Address - Fax:787-892-1514
Practice Address - Street 1:ST GUAYACAN 28 SANTA ELENA
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-1437
Practice Address - Country:US
Practice Address - Phone:787-892-1500
Practice Address - Fax:787-892-1514
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23461835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2346OtherPHARMACIST LICENSE