Provider Demographics
NPI:1639692197
Name:CRUZ, YAMIL (RPH)
Entity Type:Individual
Prefix:
First Name:YAMIL
Middle Name:
Last Name:CRUZ
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:AVE LOS DOMINICOS ESQ SABANA SECA
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-784-0270
Mailing Address - Fax:787-784-0636
Practice Address - Street 1:AVE LOS DOMINICOS ESQ SABANA SECA
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-0270
Practice Address - Fax:787-784-0636
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty