Provider Demographics
NPI:1245369560
Name:MARRERO, LOURDES ELENA I
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:ELENA
Last Name:MARRERO
Suffix:I
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:LOURDES
Other - Middle Name:ELENA
Other - Last Name:MARRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 VISTA DE LA BAHIA
Mailing Address - Street 2:PANORAMA VILLAGE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-4404
Mailing Address - Country:US
Mailing Address - Phone:787-279-3674
Mailing Address - Fax:
Practice Address - Street 1:D32 CALLE MARGINAL
Practice Address - Street 2:EXTENCION FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5555
Practice Address - Country:US
Practice Address - Phone:787-620-9602
Practice Address - Fax:787-786-0591
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist