Provider Demographics
NPI:1134246416
Name:IRIZARRY, ADELLE
Entity type:Individual
Prefix:
First Name:ADELLE
Middle Name:
Last Name:IRIZARRY
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 1:4863 CALLE EL TEMIDO
Mailing Address - Street 2:EXT. PUNTO ORO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2112
Mailing Address - Country:US
Mailing Address - Phone:787-601-1743
Mailing Address - Fax:
Practice Address - Street 1:4863 CALLE EL TEMIDO
Practice Address - Street 2:EXT. PUNTO ORO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2112
Practice Address - Country:US
Practice Address - Phone:787-601-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1520183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician