Provider Demographics
NPI:1356726384
Name:COLON, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:COLON
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 1:67 CALLE 65 INFANTERIA
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2921
Mailing Address - Country:US
Mailing Address - Phone:787-826-2545
Mailing Address - Fax:787-826-4022
Practice Address - Street 1:67 CALLE 65 INFANTERIA
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2921
Practice Address - Country:US
Practice Address - Phone:787-826-2545
Practice Address - Fax:787-826-4022
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5069183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician