Provider Demographics
NPI:1609270735
Name:LEBRON, ISMARIE SR
Entity Type:Individual
Prefix:
First Name:ISMARIE
Middle Name:
Last Name:LEBRON
Suffix:SR
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 1:24 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-2148
Mailing Address - Country:US
Mailing Address - Phone:787-943-4841
Mailing Address - Fax:939-329-7082
Practice Address - Street 1:24 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707-2148
Practice Address - Country:US
Practice Address - Phone:787-943-4841
Practice Address - Fax:393-329-7082
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9426183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9426OtherSTATE LICENSE