Provider Demographics
NPI:1902017379
Name:MALDONADO-PEREZ, MARJORIE
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:MALDONADO-PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A26 CALLE 1
Mailing Address - Street 2:CONDADO MODERNO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2418
Mailing Address - Country:US
Mailing Address - Phone:787-622-5726
Mailing Address - Fax:888-899-6747
Practice Address - Street 1:383 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2131
Practice Address - Country:US
Practice Address - Phone:787-622-5726
Practice Address - Fax:888-899-6747
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist