Provider Demographics
NPI:1295262152
Name:PAGAN, EDITH MARTA (RPH)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:MARTA
Last Name:PAGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9360
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9360
Mailing Address - Country:US
Mailing Address - Phone:787-424-3360
Mailing Address - Fax:401-216-3705
Practice Address - Street 1:9615 AVE LOS ROMEROS STE 515
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7062
Practice Address - Country:US
Practice Address - Phone:787-708-3490
Practice Address - Fax:401-216-3705
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist