Provider Demographics
NPI:1518598630
Name:LUGO, BELKIS AILEEN (R,PH)
Entity Type:Individual
Prefix:DR
First Name:BELKIS
Middle Name:AILEEN
Last Name:LUGO
Suffix:
Gender:F
Credentials:R,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 AVE HOSTOS APT PH-D
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4200
Mailing Address - Country:US
Mailing Address - Phone:787-435-8309
Mailing Address - Fax:787-621-0111
Practice Address - Street 1:175 AVE HOSTOS APT PH-D
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4200
Practice Address - Country:US
Practice Address - Phone:787-435-8309
Practice Address - Fax:787-621-0111
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3661OtherSTATE