Provider Demographics
NPI:1376087205
Name:BERRIOS, DAMARIS (RPH)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:BERRIOS
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 1:90 MENTA
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:407-227-3653
Mailing Address - Fax:
Practice Address - Street 1:200 AVE RAFAEL CORDERO
Practice Address - Street 2:COSTCO PHARMACY PLAZA CENTRO MALL II
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3740
Practice Address - Country:US
Practice Address - Phone:787-653-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist