Provider Demographics
NPI:1265939177
Name:SEVILLA TORRES, JONATHAN (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SEVILLA TORRES
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:SEVILLA TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACY TECHNICIAN
Mailing Address - Street 1:HC 69 BOX 15520
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-0007
Mailing Address - Country:US
Mailing Address - Phone:787-590-4995
Mailing Address - Fax:
Practice Address - Street 1:999 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2719
Practice Address - Country:US
Practice Address - Phone:787-294-0407
Practice Address - Fax:787-294-0503
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012562183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician