Provider Demographics
NPI:1205578564
Name:GRAULAU, RAFAEL ENRIQUE
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:ENRIQUE
Last Name:GRAULAU
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 1:469 AVE ESMERALDA
Mailing Address - Street 2:COND PLAZA ESMERALDA APT 122
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-307-5920
Mailing Address - Fax:
Practice Address - Street 1:35 CALLE JUAN C BORBON STE 77
Practice Address - Street 2:DF02400-0
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-287-3725
Practice Address - Fax:787-287-3711
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4988842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4093048Other4093048
PR4093048OtherPHARMACY INTERN EMPLOYEE ID