Provider Demographics
NPI:1659742500
Name:MORALES, ELBA D
Entity Type:Individual
Prefix:MRS
First Name:ELBA
Middle Name:D
Last Name:MORALES
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 251
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0251
Mailing Address - Country:US
Mailing Address - Phone:787-589-7281
Mailing Address - Fax:787-589-7283
Practice Address - Street 1:CARR. 411 KM 2.8
Practice Address - Street 2:BO. JAGUEY
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-589-7281
Practice Address - Fax:787-589-7283
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17-F-33203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy