Provider Demographics
NPI:1609038371
Name:COLON-VILLANUEVA, LIZETTE (RPH)
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:COLON-VILLANUEVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LIZETTE
Other - Middle Name:
Other - Last Name:COLON-RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7958 LA MIRANDA DR.
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:941-391-0081
Mailing Address - Fax:
Practice Address - Street 1:27680 BERMONT RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-1901
Practice Address - Country:US
Practice Address - Phone:941-505-9583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist