Provider Demographics
NPI:1265146534
Name:CAMACHO VELAZQUEZ, LIZMARIE
Entity type:Individual
Prefix:
First Name:LIZMARIE
Middle Name:
Last Name:CAMACHO VELAZQUEZ
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 1:2511 PONCE BYP
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1305
Mailing Address - Country:US
Mailing Address - Phone:787-284-2500
Mailing Address - Fax:
Practice Address - Street 1:2511 PONCE BYP
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1305
Practice Address - Country:US
Practice Address - Phone:787-284-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist