Provider Demographics
NPI:1023096609
Name:MORA, AGNES N (RPH)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:N
Last Name:MORA
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 857
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0857
Mailing Address - Country:US
Mailing Address - Phone:787-256-4518
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE MUNOZ RIVERA S
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-6246
Practice Address - Country:US
Practice Address - Phone:787-768-5373
Practice Address - Fax:787-776-3640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist