Provider Demographics
NPI:1790801769
Name:BOU CORDOVA, ANGELA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:BOU CORDOVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 29030
Mailing Address - Street 2:PMB 117
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8900
Mailing Address - Country:US
Mailing Address - Phone:787-287-7931
Mailing Address - Fax:787-786-4564
Practice Address - Street 1:HC 1 BOX 29030
Practice Address - Street 2:PMB 117
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-8900
Practice Address - Country:US
Practice Address - Phone:787-287-7931
Practice Address - Fax:787-786-4564
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist