Provider Demographics
NPI:1659573533
Name:DE JESUS, LYMARI
Entity Type:Individual
Prefix:
First Name:LYMARI
Middle Name:
Last Name:DE JESUS
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:PO BOX 1811
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1811
Mailing Address - Country:US
Mailing Address - Phone:939-640-4190
Mailing Address - Fax:877-204-3025
Practice Address - Street 1:POBLADO SAN ANTONIO CARR 110 KM 6.2
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00690
Practice Address - Country:US
Practice Address - Phone:787-890-3535
Practice Address - Fax:787-890-3535
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR183700000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183700000XPharmacy Service ProvidersPharmacy Technician
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3040AFOtherPHARMACIST ASSIT LICENCE