Provider Demographics
NPI:1508088329
Name:CRUZ, RICARDO (RPH)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
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:SAN IGNACIO 250 STREET
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-832-6355
Mailing Address - Fax:787-833-8872
Practice Address - Street 1:SAN IGNACIO 250 STREET
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-6355
Practice Address - Fax:787-833-8872
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2964OtherPHARMACIST STATE LICENCE