Provider Demographics
NPI:1679239032
Name:COLON JUAN, ANDRES AMID
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:AMID
Last Name:COLON JUAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CARR 149 STE 1
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-9661
Mailing Address - Country:US
Mailing Address - Phone:787-871-3105
Mailing Address - Fax:
Practice Address - Street 1:CARR. 149 KM 9.8 EXPRESO DE CIALES A MANATI
Practice Address - Street 2:BO. HATO VIEJO SECTOR CAMPAMENTO
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-9661
Practice Address - Country:US
Practice Address - Phone:787-871-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist