Provider Demographics
NPI:1629473699
Name:REYES, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:REYES
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:#37 GARDENIA STREET
Mailing Address - Street 2:CONDOMINIO REINA DEL MAR APT 19-D
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-8017
Mailing Address - Country:US
Mailing Address - Phone:787-360-6827
Mailing Address - Fax:
Practice Address - Street 1:37 CALLE GARDENIA
Practice Address - Street 2:CONDO REINA DEL MAR APT 19-D
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-8011
Practice Address - Country:US
Practice Address - Phone:787-360-6827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2719183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician