Provider Demographics
NPI:1477577229
Name:CRUZ, IVETTE M (RPH)
Entity Type:Individual
Prefix:MS
First Name:IVETTE
Middle Name:M
Last Name:CRUZ
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 1:1 CALLE HORTENSIA
Mailing Address - Street 2:COND SKY TOWER I APT 3-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6407
Mailing Address - Country:US
Mailing Address - Phone:787-287-7415
Mailing Address - Fax:
Practice Address - Street 1:327 AVE BARBOSA
Practice Address - Street 2:SUPER FARMACIA BARBOSA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3314
Practice Address - Country:US
Practice Address - Phone:787-763-8477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist