Provider Demographics
NPI:1629221809
Name:CANCEL MARIN, NILDA I (RPH)
Entity Type:Individual
Prefix:
First Name:NILDA
Middle Name:I
Last Name:CANCEL MARIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CALLE FEDERICO COSTA
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1310
Mailing Address - Country:US
Mailing Address - Phone:787-523-1000
Mailing Address - Fax:787-523-1004
Practice Address - Street 1:205 CALLE FEDERICO COSTA
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1310
Practice Address - Country:US
Practice Address - Phone:787-523-1000
Practice Address - Fax:787-523-1004
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist