Provider Demographics
NPI:1740303957
Name:COLON, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 1 PARCELAS 373A LA CENTRAL
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-550-4081
Mailing Address - Fax:787-769-5353
Practice Address - Street 1:800 AVE RAFAEL HDEZ MARIN
Practice Address - Street 2:STE 5 FARMACIA AMIGA DE MONTECARLO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-5288
Practice Address - Country:US
Practice Address - Phone:787-762-1616
Practice Address - Fax:787-769-5353
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5575183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician