Provider Demographics
NPI:1689841132
Name:COLON, LOURDES M (PHARM D)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:COLON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 NW 80TH LN
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-6046
Mailing Address - Country:US
Mailing Address - Phone:305-887-7715
Mailing Address - Fax:
Practice Address - Street 1:20601 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2441
Practice Address - Country:US
Practice Address - Phone:305-259-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5053183500000X
FLPS43044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist