Provider Demographics
NPI:1689311136
Name:MORALES ROLDAN, JOSUE JOEL
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:JOEL
Last Name:MORALES ROLDAN
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:HC 9 BOX 10311
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9274
Mailing Address - Country:US
Mailing Address - Phone:787-324-2705
Mailing Address - Fax:
Practice Address - Street 1:150 CALLE F VIZCARRONDO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4483
Practice Address - Country:US
Practice Address - Phone:787-755-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist