Provider Demographics
NPI:1568509933
Name:ROSADO, LOURDES
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:ROSADO
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:HC 1 BOX 3592
Mailing Address - Street 2:BO. MAVILLA
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-9629
Mailing Address - Country:US
Mailing Address - Phone:787-859-7868
Mailing Address - Fax:787-794-0620
Practice Address - Street 1:HC 1 BOX 3592
Practice Address - Street 2:BO. MAVILLA
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-9629
Practice Address - Country:US
Practice Address - Phone:787-859-7868
Practice Address - Fax:787-794-0620
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist