Provider Demographics
NPI:1356636021
Name:GARCIA PLAZA, FERMIN (RPH)
Entity Type:Individual
Prefix:
First Name:FERMIN
Middle Name:
Last Name:GARCIA PLAZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE TOMAS DIAZ RIVERA - 130
Mailing Address - Street 2:PASEO DE LOS ARTESANOS
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9650
Mailing Address - Country:US
Mailing Address - Phone:787-914-6327
Mailing Address - Fax:
Practice Address - Street 1:WALGREEN'S - LAS PIEDRAS SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-5670
Practice Address - Fax:787-733-5741
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3608OtherSTATE LICENSE