Provider Demographics
NPI:1700223062
Name:LUQUE, KEVIN JAVIER (PHARM TECH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAVIER
Last Name:LUQUE
Suffix:
Gender:M
Credentials:PHARM TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 6560
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-9015
Mailing Address - Country:US
Mailing Address - Phone:787-585-5117
Mailing Address - Fax:787-732-4799
Practice Address - Street 1:CARR. 156 KM 49.0
Practice Address - Street 2:BO. MULAS
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-732-4799
Practice Address - Fax:787-732-4799
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8542183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8542OtherPHARMACY TECH LICENSE