Provider Demographics
NPI:1649898172
Name:MOJICA, LUIS EMANUEL (TECNICHIAN PHARMACY)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:EMANUEL
Last Name:MOJICA
Suffix:
Gender:M
Credentials:TECNICHIAN PHARMACY
Other - Prefix:MR
Other - First Name:LUIS
Other - Middle Name:EMANUEL
Other - Last Name:MOJICA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TECNICHIAN PHARMACY
Mailing Address - Street 1:BO. MALPICA SECT. MONTE BELLO
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-223-7760
Mailing Address - Fax:
Practice Address - Street 1:CARR. PR 3 KM 9.5 AVE. 65 DE INFANTERIA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-620-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12992183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician