Provider Demographics
NPI:1912031832
Name:PESANTE, EVA I (RPH)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:I
Last Name:PESANTE
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 1085
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1085
Mailing Address - Country:US
Mailing Address - Phone:787-849-4173
Mailing Address - Fax:787-849-4176
Practice Address - Street 1:CARR. 102 CENTRO PROFESIONAL BORINQUEN FCIA. BELMONTE
Practice Address - Street 2:SUITE 101
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3308
Practice Address - Country:US
Practice Address - Phone:787-851-1500
Practice Address - Fax:787-254-0230
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
PR3866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist