Provider Demographics
NPI:1407551773
Name:ALMODOVAR PEREZ, NICOLE M (TEC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:ALMODOVAR PEREZ
Suffix:
Gender:F
Credentials:TEC
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ALMODOVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4406 AVE MILITAR
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4158
Mailing Address - Country:US
Mailing Address - Phone:787-830-7472
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA SEVERIANO CUEVAS #18
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-658-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR015120183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician