Provider Demographics
NPI:1689790156
Name:MALDONADO, NERY I
Entity Type:Individual
Prefix:
First Name:NERY
Middle Name:I
Last Name:MALDONADO
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:URBANIZACION PASEOS REALES 739
Mailing Address - Street 2:AVENIDA EMPERADOR
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-349-0710
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #2 KM 62.7
Practice Address - Street 2:SECTOR CANDELARIA
Practice Address - City:SABANA HOYOS
Practice Address - State:PR
Practice Address - Zip Code:00688
Practice Address - Country:US
Practice Address - Phone:787-881-2440
Practice Address - Fax:787-880-3258
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2261183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician