Provider Demographics
NPI:1639208879
Name:JIMENEZ JIMENEZ, CARMEN (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:JIMENEZ JIMENEZ
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:JIMENEZ JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACY TECHNICIAN
Mailing Address - Street 1:HC-02 BOX 20346
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-896-1850
Mailing Address - Fax:787-280-1698
Practice Address - Street 1:CALLE JOSE MENDEZ CARDONA # 3
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1850
Practice Address - Fax:787-280-1698
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1674183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1674OtherREGISTRO FARMACIA