Provider Demographics
NPI:1760996615
Name:LEDESMA-MALDONADO, SELIMAR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SELIMAR
Middle Name:
Last Name:LEDESMA-MALDONADO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CALLE GLADIOLA
Mailing Address - Street 2:URBANIZATION CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-619-4664
Mailing Address - Fax:
Practice Address - Street 1:30 AVE RAFAEL CORDERO HWY
Practice Address - Street 2:7419 KMART PHARMACY
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-746-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist