Provider Demographics
NPI:1720106271
Name:VELEZ, LISANDRA (PHARMACIST TECHNICIA)
Entity Type:Individual
Prefix:MRS
First Name:LISANDRA
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:PHARMACIST TECHNICIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:APARTADO 1144
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-1144
Mailing Address - Country:US
Mailing Address - Phone:787-239-4998
Mailing Address - Fax:787-897-3231
Practice Address - Street 1:23 CALLE RAMON DE JESUS SIERRA
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2204
Practice Address - Country:US
Practice Address - Phone:787-897-2464
Practice Address - Fax:787-897-3231
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005732183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4240633OtherDRIVER LIC