Provider Demographics
NPI:1538476353
Name:FORTIS, HILDA MILAGROS (TECNICO DE FARMACIA)
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:MILAGROS
Last Name:FORTIS
Suffix:
Gender:F
Credentials:TECNICO DE FARMACIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ELODEA 2G #28 LOMAS VERDES
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-0000
Mailing Address - Country:US
Mailing Address - Phone:787-619-2772
Mailing Address - Fax:
Practice Address - Street 1:CALLE TENIENTE CESAR GONZALES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-0000
Practice Address - Country:US
Practice Address - Phone:787-758-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1081183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician