Provider Demographics
NPI:1912178195
Name:SERRANO RIVERA, LOURDES JANETTE (PHARNACY TEC)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:JANETTE
Last Name:SERRANO RIVERA
Suffix:
Gender:F
Credentials:PHARNACY TEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 4829
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9459
Mailing Address - Country:US
Mailing Address - Phone:787-205-8172
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL RYDER AVE FONT MARTELO
Practice Address - Street 2:03
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1500183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician