Provider Demographics
NPI:1912044488
Name:JIMENEZ-COLON, MARIE CELIDA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:CELIDA
Last Name:JIMENEZ-COLON
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 1:120 AVE LA SIERRA
Mailing Address - Street 2:BOX 17
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4344
Mailing Address - Country:US
Mailing Address - Phone:787-790-1128
Mailing Address - Fax:787-765-7242
Practice Address - Street 1:1007 AVE MUNOZ RIVERA
Practice Address - Street 2:EDIFICIO DARLINGTON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2717
Practice Address - Country:US
Practice Address - Phone:787-767-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4275OtherSTATE LICENSE