Provider Demographics
NPI:1700051737
Name:BURGOS, LILLIAN VEGA (PHTECH)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:VEGA
Last Name:BURGOS
Suffix:
Gender:F
Credentials:PHTECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 02 BOX 35127
Mailing Address - Street 2:SECTOR EL JUNCO
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-955-2420
Mailing Address - Fax:787-816-5837
Practice Address - Street 1:CARRETRA 651 KM 2.5
Practice Address - Street 2:SECTOR EL JUNCO EN ARECIBO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-955-2420
Practice Address - Fax:787-816-5837
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004521183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician