Provider Demographics
NPI:1508083080
Name:BURGOS, LIZMARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LIZMARIE
Middle Name:
Last Name:BURGOS
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:COND. EL BOSQUE, 146 AVE. SANTA ANA BOX 901
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-215-7973
Mailing Address - Fax:
Practice Address - Street 1:AVE. SANTA CRUZ
Practice Address - Street 2:HOSPITAL SANPABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-620-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist