Provider Demographics
NPI:1184378663
Name:PIETRI, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PIETRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 CALLE CARMEN HERNANDEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3518
Mailing Address - Country:US
Mailing Address - Phone:787-752-0315
Mailing Address - Fax:
Practice Address - Street 1:932 CALLE CARMEN HERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3518
Practice Address - Country:US
Practice Address - Phone:787-752-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3002OtherLICENSE