Provider Demographics
NPI:1568732030
Name:SIERRA, IVELISSE (RPH)
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:SIERRA
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:ESTANCIAS DE CERRO GORDO PLAZA TIFANY
Mailing Address - Street 2:24
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9118
Mailing Address - Country:US
Mailing Address - Phone:787-627-3543
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 COLINA REAL
Practice Address - Street 2:100 LAS COLINAS
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00951-0000
Practice Address - Country:US
Practice Address - Phone:787-627-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist