Provider Demographics
NPI:1750675765
Name:COLON BURGOS, KARENLY (PHARN D)
Entity Type:Individual
Prefix:
First Name:KARENLY
Middle Name:
Last Name:COLON BURGOS
Suffix:
Gender:F
Credentials:PHARN D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDA SAN JOSE 1439 COND PUERTA DEL PARQUE
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-607-1763
Mailing Address - Fax:
Practice Address - Street 1:200 AVE RAFAEL CORDERO # FARMACIA
Practice Address - Street 2:200 AVE RAFAEL CORDERO STE 41
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3740
Practice Address - Country:US
Practice Address - Phone:787-745-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist