Provider Demographics
NPI:1912031816
Name:VELEZ, MAYRA (PH)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:PH
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 486
Mailing Address - Street 2:PILETAS ARCE
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0486
Mailing Address - Country:US
Mailing Address - Phone:787-897-7012
Mailing Address - Fax:787-897-2725
Practice Address - Street 1:STREET 111 HM 1.9
Practice Address - Street 2:AVE. LOS PATRIOTAS
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-2727
Practice Address - Fax:787-897-2725
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3136OtherPHARMACIST