Provider Demographics
NPI:1467091603
Name:ROSA, GLORIMILDA
Entity Type:Individual
Prefix:MRS
First Name:GLORIMILDA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:
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 1493
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1493
Mailing Address - Country:US
Mailing Address - Phone:787-691-1250
Mailing Address - Fax:
Practice Address - Street 1:AVE. PEDRO MORA
Practice Address - Street 2:CARR 129 KM 0.7
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-680-0029
Practice Address - Fax:787-680-0030
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist