Provider Demographics
NPI:1336524362
Name:VILLAFANE, WILFREDO (RPH)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:VILLAFANE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 AVE MILITAR STE 193
Mailing Address - Street 2:PLAZA ISABELA
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4046
Mailing Address - Country:US
Mailing Address - Phone:787-830-3004
Mailing Address - Fax:787-830-3474
Practice Address - Street 1:3535 AVE MILITAR STE 193
Practice Address - Street 2:PLAZA ISABELA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4046
Practice Address - Country:US
Practice Address - Phone:787-830-3004
Practice Address - Fax:787-830-3474
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist