Provider Demographics
NPI:1689250862
Name:LABOY, LUIS RAFAEL (RPH)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RAFAEL
Last Name:LABOY
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:LA RAMBLA
Mailing Address - Street 2:#1111 CALLE AVILA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-604-1074
Mailing Address - Fax:
Practice Address - Street 1:URB. LA VEGA CARR.151 KM0.4
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-0076
Practice Address - Country:US
Practice Address - Phone:787-847-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1552459OtherOTC