Provider Demographics
NPI:1609093046
Name:MARRERO, WANDA
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:MARRERO
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:C15 CALLE ISABEL LA CATOLICA
Mailing Address - Street 2:MANSIONES REALES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5268
Mailing Address - Country:US
Mailing Address - Phone:787-708-5192
Mailing Address - Fax:
Practice Address - Street 1:C15 CALLE ISABEL LA CATOLICA
Practice Address - Street 2:MANSIONES REALES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5268
Practice Address - Country:US
Practice Address - Phone:787-708-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3352OtherPHARMACIST