Provider Demographics
NPI:1689712648
Name:MALAVE, ENEIDA LISSETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ENEIDA
Middle Name:LISSETTE
Last Name:MALAVE
Suffix:
Gender:F
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:TULANE ST. 409 ESTANCIAS DE TORTUGUERO
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-807-3740
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE QUINONES
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5013
Practice Address - Country:US
Practice Address - Phone:787-854-2292
Practice Address - Fax:787-854-3503
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist