Provider Demographics
NPI:1558443416
Name:CORREA, LISANDRA (PHT)
Entity Type:Individual
Prefix:MRS
First Name:LISANDRA
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:PHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARRIO ARENA SECTOR VISTA ALEGRE
Mailing Address - Street 2:BARRIO ARENA SECTOR VISTA ALEGRE PMB 458 P.O.BOX 6400
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-6400
Mailing Address - Country:US
Mailing Address - Phone:787-269-5689
Mailing Address - Fax:
Practice Address - Street 1:BARRIO ARENA SECTOR VISTA ALEGRE
Practice Address - Street 2:BARRIO ARENA SECTOR VISTA ALEGRE PMB 458
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-6400
Practice Address - Country:US
Practice Address - Phone:787-269-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3367183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician