Provider Demographics
NPI:1407983059
Name:SIERRA, ELDA (RPH)
Entity Type:Individual
Prefix:
First Name:ELDA
Middle Name:
Last Name:SIERRA
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:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1156
Mailing Address - Country:US
Mailing Address - Phone:787-402-7260
Mailing Address - Fax:787-884-5756
Practice Address - Street 1:BARRIO COTO NORTE SECTOR CANTERA
Practice Address - Street 2:RD # 2 KM 44.5
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-1156
Practice Address - Country:US
Practice Address - Phone:787-402-7260
Practice Address - Fax:787-884-5756
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2817OtherPHARMACIST STATE LICENCE