Provider Demographics
NPI:1891328449
Name:CORTES HERNANDEZ, MARISOL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:CORTES HERNANDEZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HN-31 CALLE 254
Mailing Address - Street 2:EXT III COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-2635
Mailing Address - Country:US
Mailing Address - Phone:787-439-0410
Mailing Address - Fax:
Practice Address - Street 1:CARR. #3 KM. 32.9 BO. TRES T
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-888-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4351OtherJUNTA DE FARMACIA