Provider Demographics
NPI:1689911133
Name:CANET, WALDEMAR
Entity Type:Individual
Prefix:MR
First Name:WALDEMAR
Middle Name:
Last Name:CANET
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:BDA.FERRAN
Mailing Address - Street 2:STREET C # 53
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:939-275-7186
Mailing Address - Fax:
Practice Address - Street 1:KMART PHARMACY
Practice Address - Street 2:CARR.2 CALLE BARAMAY
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-812-1616
Practice Address - Fax:787-812-1625
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8436183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician