Provider Demographics
NPI:1851505473
Name:BERRIOS, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC- 72 BOX 3762
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719
Mailing Address - Country:US
Mailing Address - Phone:787-786-9610
Mailing Address - Fax:
Practice Address - Street 1:URB.SIERRA BAYAMON
Practice Address - Street 2:28-20 AVE. NORTH MAIN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4329
Practice Address - Country:US
Practice Address - Phone:787-786-9610
Practice Address - Fax:787-786-9610
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4546183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician