Provider Demographics
NPI:1376751842
Name:ROSARIO, MAYRA LEE (FA)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:LEE
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. PLACITA
Mailing Address - Street 2:HC01 BOX 5816
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9706
Mailing Address - Country:US
Mailing Address - Phone:939-579-7205
Mailing Address - Fax:
Practice Address - Street 1:CALLE ALGARIN ESQUINA DR. BARRERAS
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-9706
Practice Address - Country:US
Practice Address - Phone:939-579-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003593183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician