Provider Demographics
NPI:1629581293
Name:RIOS, EVALISSE (PHARMACY TECH)
Entity Type:Individual
Prefix:
First Name:EVALISSE
Middle Name:
Last Name:RIOS
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 164 KM 0.2 SECTOR DESVIO
Mailing Address - Street 2:PO BOX 923
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 164 KM 0.2
Practice Address - Street 2:SECTOR DESVIO
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11910183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician