Provider Demographics
NPI:1871658823
Name:GERENA, EFRAIN
Entity Type:Individual
Prefix:MR
First Name:EFRAIN
Middle Name:
Last Name:GERENA
Suffix:
Gender:M
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 5 BOX 57253
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9587
Mailing Address - Country:US
Mailing Address - Phone:787-891-2092
Mailing Address - Fax:787-868-2300
Practice Address - Street 1:90 CALLE COLON
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3105
Practice Address - Country:US
Practice Address - Phone:787-868-2300
Practice Address - Fax:787-868-2300
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR867183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician