Provider Demographics
NPI:1891071692
Name:DELGADO RIVERA, EDWIN (RPH)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:DELGADO RIVERA
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:P.O. BOX 1526
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:939-202-5866
Mailing Address - Fax:787-286-8249
Practice Address - Street 1:500 STATE ROAD 1 ALTOS DE LA FUENTE
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-286-8242
Practice Address - Fax:787-286-8249
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist