Provider Demographics
NPI:1861850976
Name:DIAZ, PABLO ANTONIO (B S PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:ANTONIO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:B S PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CALLE BALDOMAR
Mailing Address - Street 2:URB MUNOZ RIVERA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3536
Mailing Address - Country:US
Mailing Address - Phone:787-720-4296
Mailing Address - Fax:
Practice Address - Street 1:198 AVE ESMERALDA
Practice Address - Street 2:URB PONCE DE LEON
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4448
Practice Address - Country:US
Practice Address - Phone:787-790-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist