Provider Demographics
NPI:1619324951
Name:MONTALVO, LYSVETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LYSVETTE
Middle Name:
Last Name:MONTALVO
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:A4 EXTENCION LA CONCEPCION
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-538-3796
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE ZUZUARREGUI
Practice Address - Street 2:
Practice Address - City:MARICAO
Practice Address - State:PR
Practice Address - Zip Code:00606
Practice Address - Country:US
Practice Address - Phone:787-838-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist