Provider Demographics
NPI:1811214034
Name:PUERTA, LUZ MARINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUZ MARINA
Middle Name:
Last Name:PUERTA
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:PO BOX 366656
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6656
Mailing Address - Country:US
Mailing Address - Phone:787-792-3725
Mailing Address - Fax:787-774-0555
Practice Address - Street 1:AVE FD ROOSEVELT
Practice Address - Street 2:WALGREENS OF SAN PATRICIO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2736
Practice Address - Country:US
Practice Address - Phone:787-792-3725
Practice Address - Fax:787-774-0555
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist