Provider Demographics
NPI:1891335048
Name:CHICO, LESLIE IVETTE (RPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:IVETTE
Last Name:CHICO
Suffix:
Gender:F
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:PO BOX 991
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0991
Mailing Address - Country:US
Mailing Address - Phone:787-868-6240
Mailing Address - Fax:787-868-3589
Practice Address - Street 1:CARR 417 KM 3.0
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-6240
Practice Address - Fax:787-868-3589
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist