Provider Demographics
NPI:1598217150
Name:LEBRON, MARISOL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CARR 116 STE1
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-923-7178
Mailing Address - Fax:787-899-8359
Practice Address - Street 1:CARR 116 INT CARR 304 KM 0.1
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-8719
Practice Address - Fax:787-899-8359
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist