Provider Demographics
NPI:1558442749
Name:AYALA, ANELIESE (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANELIESE
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 CALLE FLORES
Mailing Address - Street 2:URB MANSIONES DE RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7214
Mailing Address - Country:US
Mailing Address - Phone:787-760-2875
Mailing Address - Fax:787-761-1025
Practice Address - Street 1:CENTRA COMERCIAL LITHEDA 107
Practice Address - Street 2:CARR 845 CUPEY BAJO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-761-4205
Practice Address - Fax:787-761-1025
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist