Provider Demographics
NPI:1629617881
Name:AGOSTO-TRENCHE, VIRGILIO (RPH)
Entity Type:Individual
Prefix:MR
First Name:VIRGILIO
Middle Name:
Last Name:AGOSTO-TRENCHE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 TRINITARIA ST
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2217
Mailing Address - Country:US
Mailing Address - Phone:787-374-2188
Mailing Address - Fax:
Practice Address - Street 1:80 CALLE AUTONOMIA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3242
Practice Address - Country:US
Practice Address - Phone:787-876-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3747OtherSTATE LICENSE