Provider Demographics
NPI:1528194891
Name:ESPARRA, LOURDES MICHELLE
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:MICHELLE
Last Name:ESPARRA
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 1:194 VALLES DE TORRIMAR
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-785-0767
Mailing Address - Fax:787-749-9435
Practice Address - Street 1:FCIA. PLAZA GARDEN HILLS PLAZA
Practice Address - Street 2:LOCAL 28
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-781-8179
Practice Address - Fax:787-749-9435
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4994OtherPHARMACIST LIC.