Provider Demographics
NPI:1356493076
Name:TOSADO, PEDRO J SR
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:J
Last Name:TOSADO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:MARITZA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:LINARES STREET
Mailing Address - Street 2:205
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-895-5702
Mailing Address - Fax:787-895-5702
Practice Address - Street 1:CALLE LINARES
Practice Address - Street 2:205
Practice Address - City:QUEBRADILLAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00678
Practice Address - Country:UM
Practice Address - Phone:787-895-5702
Practice Address - Fax:787-895-5702
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-1498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist