Provider Demographics
NPI:1902360480
Name:FORNES AQUINO, RAFAEL ISAAC (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ISAAC
Last Name:FORNES AQUINO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 AVE LOS ROMEROS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7007
Mailing Address - Country:US
Mailing Address - Phone:787-282-2291
Mailing Address - Fax:
Practice Address - Street 1:9410 AVE LOS ROMEROS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7007
Practice Address - Country:US
Practice Address - Phone:787-282-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist