Provider Demographics
NPI:1376265249
Name:MAS-KILDARE, VIVIANNA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:VIVIANNA
Middle Name:M
Last Name:MAS-KILDARE
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 1:9615 AVE LOS ROMEROS STE 1100
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7056
Mailing Address - Country:US
Mailing Address - Phone:787-625-2500
Mailing Address - Fax:
Practice Address - Street 1:URB. PARQUE MONTEBELLO
Practice Address - Street 2:F-13 2ND STREET
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-909-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist