Provider Demographics
NPI:1154960359
Name:DELGADO, EDNA LYDIA (RPH)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:LYDIA
Last Name:DELGADO
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 8352
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8352
Mailing Address - Country:US
Mailing Address - Phone:787-219-8971
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE FONT MARTELO E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3617
Practice Address - Country:US
Practice Address - Phone:787-656-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist