Provider Demographics
NPI:1558442707
Name:HUERTAS, JOAQUIN SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:
Last Name:HUERTAS
Suffix:SR
Gender:M
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:EXTENSION ALTAVISTA
Mailing Address - Street 2:17TH STREET XX17
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4286
Mailing Address - Country:US
Mailing Address - Phone:787-677-6505
Mailing Address - Fax:
Practice Address - Street 1:EXTENSION ALTAVISTA
Practice Address - Street 2:17TH STREET XX17
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4286
Practice Address - Country:US
Practice Address - Phone:787-677-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist