Provider Demographics
NPI:1942776547
Name:GOMEZ, CARMEN YAJAIRA (PHARMACIST TECH)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:YAJAIRA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PHARMACIST TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA CLARA CARR 9931 SUITE 1
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-687-7997
Mailing Address - Fax:787-687-7994
Practice Address - Street 1:URB. SANTA CLARA CARR 9931 SUITE 1
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-687-7997
Practice Address - Fax:787-687-7994
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11562183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4678295OtherDRIVERS