Provider Demographics
NPI:1457423733
Name:RAICES, YOLANDA (PHARMASIST TECHNITIO)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:RAICES
Suffix:
Gender:F
Credentials:PHARMASIST TECHNITIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 486 ESQ. 455
Mailing Address - Street 2:BO. QUEBRADA
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627
Mailing Address - Country:US
Mailing Address - Phone:787-452-1519
Mailing Address - Fax:787-898-7999
Practice Address - Street 1:CARR 486 ESQ, 455
Practice Address - Street 2:HC 02 BOX 7856
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-452-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5306183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRYOLYTITOMedicare UPIN