Provider Demographics
NPI:1922142280
Name:DETRES, DEBBIE SUZANNE
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:SUZANNE
Last Name:DETRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CARR 849
Mailing Address - Street 2:CONDOMINIO VISTA VERDE APT. F228
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4563
Mailing Address - Country:US
Mailing Address - Phone:787-276-3456
Mailing Address - Fax:
Practice Address - Street 1:1200 CARR 849
Practice Address - Street 2:CONDOMINIO VISTA VERDE APT. F228
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4563
Practice Address - Country:US
Practice Address - Phone:787-276-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2244183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician