Provider Demographics
NPI:1851768535
Name:COLLAZO, LUIS E (RPH)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:COLLAZO
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 1:453 CALLE CONSTANCIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-3813
Mailing Address - Country:US
Mailing Address - Phone:876-404-3627
Mailing Address - Fax:
Practice Address - Street 1:453 CALLE CONSTANCIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-3813
Practice Address - Country:US
Practice Address - Phone:787-640-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist