Provider Demographics
NPI:1689705519
Name:COLON, MAGDALENA
Entity Type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:
Last Name:COLON
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:HC3 BOX 10475 BARRIO GUAYABOTAS
Mailing Address - Street 2:CARRETERA 182
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-206-0474
Mailing Address - Fax:787-893-3376
Practice Address - Street 1:CALLE SATURNINO RODRIGUEZ # 30
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-4455
Practice Address - Fax:787-893-3376
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4905183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician