Provider Demographics
NPI:1700091386
Name:DE JESUS, IRIAN (RPH,PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IRIAN
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:RPH,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 CALLE NAVARRA
Mailing Address - Street 2:LA RAMBLA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4043
Mailing Address - Country:US
Mailing Address - Phone:787-848-7089
Mailing Address - Fax:787-651-5559
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:HOSPITAL DR. PILA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-651-5557
Practice Address - Fax:787-651-5559
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist