Provider Demographics
NPI:1578060679
Name:ANTOMMATTEI, OSVALDO ANDRES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:ANDRES
Last Name:ANTOMMATTEI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10567
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0567
Mailing Address - Country:US
Mailing Address - Phone:787-599-2539
Mailing Address - Fax:
Practice Address - Street 1:106 CALLE PIEL CANELA
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-803-6802
Practice Address - Fax:787-803-6807
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR006473OtherPHARMACIST