Provider Demographics
NPI:1407933617
Name:COLON, LOURDES AIXA (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:AIXA
Last Name:COLON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 78
Mailing Address - Street 2:
Mailing Address - City:ANGELES
Mailing Address - State:PR
Mailing Address - Zip Code:00611
Mailing Address - Country:US
Mailing Address - Phone:787-898-6378
Mailing Address - Fax:787-898-6378
Practice Address - Street 1:CARR 129 KM 15 0 BAYANEY
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-898-6378
Practice Address - Fax:787-898-6378
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist