Provider Demographics
NPI:1508132036
Name:DIAZ NAZARIO, MARIA NILDA (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:NILDA
Last Name:DIAZ NAZARIO
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:COSTCO PHARMACY
Mailing Address - Street 2:CARR 177 ESQ CALLE 24
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-993-9310
Mailing Address - Fax:787-993-9307
Practice Address - Street 1:COSTCO PHARMACY
Practice Address - Street 2:CARR 177 ESQ CALLE 24
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-993-9310
Practice Address - Fax:787-993-9307
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist