Provider Demographics
NPI:1851521264
Name:REYES, JORGE LUIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:LUIS
Last Name:REYES
Suffix:
Gender:M
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:H3 AVE SAN PATRICIO
Mailing Address - Street 2:MEADOWS TOWER APT. 10 B
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3235
Mailing Address - Country:US
Mailing Address - Phone:787-632-8319
Mailing Address - Fax:
Practice Address - Street 1:59 CALLE SANTA CRUZ
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6900
Practice Address - Country:US
Practice Address - Phone:787-740-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist