Provider Demographics
NPI:1831319094
Name:PADILLA, MARIELIS (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MARIELIS
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-73 BOX 4336
Mailing Address - Street 2:BO. ACHIOTE
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719
Mailing Address - Country:US
Mailing Address - Phone:787-249-9907
Mailing Address - Fax:
Practice Address - Street 1:AVE. JESUS T PINERO #1727
Practice Address - Street 2:SUMMIT HILLS
Practice Address - City:SAN JUAN
Practice Address - State:RI
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-792-5797
Practice Address - Fax:787-781-1734
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19308247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other