Provider Demographics
NPI:1457575326
Name:LEBRON, SIMON (RPH)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:LEBRON
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:PO BOX 10137
Mailing Address - Street 2:CUH STATION
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792
Mailing Address - Country:US
Mailing Address - Phone:787-285-8356
Mailing Address - Fax:
Practice Address - Street 1:BOULEVARD DEL RIO AVE RAMAL #3
Practice Address - Street 2:CORPORACION DEL FONDO DE SEGURO DEL ESTADO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-1400
Practice Address - Fax:787-852-9020
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist