Provider Demographics
NPI:1265440259
Name:COLON, ANDRES (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CARR 149 STE 1
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-9661
Mailing Address - Country:US
Mailing Address - Phone:787-871-3105
Mailing Address - Fax:
Practice Address - Street 1:BO CAMPAMENTO 500 CARR 149
Practice Address - Street 2:SUITE 01
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-9661
Practice Address - Country:US
Practice Address - Phone:787-871-3105
Practice Address - Fax:787-871-3122
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4758183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician