Provider Demographics
NPI:1437285467
Name:GALERA, IBIS N (RPH)
Entity Type:Individual
Prefix:
First Name:IBIS
Middle Name:N
Last Name:GALERA
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 1:954 AVE PONCE DE LEON
Mailing Address - Street 2:MIRAMAR PLAZA APT. 18C
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3646
Mailing Address - Country:US
Mailing Address - Phone:787-641-7582
Mailing Address - Fax:
Practice Address - Street 1:954 AVE PONCE DE LEON
Practice Address - Street 2:MIRAMAR PLAZA APT. 18C
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3646
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2529OtherREGISTERED PHARMACIST