Provider Demographics
NPI:1508455577
Name:MARQUEZ JIMENEZ, KHYRSIS JAELLE
Entity Type:Individual
Prefix:DR
First Name:KHYRSIS
Middle Name:JAELLE
Last Name:MARQUEZ JIMENEZ
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 260105
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2617
Mailing Address - Country:US
Mailing Address - Phone:787-566-7106
Mailing Address - Fax:
Practice Address - Street 1:400 AVE LA SIERRA # 177
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4351
Practice Address - Country:US
Practice Address - Phone:787-292-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist