Provider Demographics
NPI:1740492446
Name:PENA, ARACELIS
Entity type:Individual
Prefix:
First Name:ARACELIS
Middle Name:
Last Name:PENA
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:F35 CALLE B
Mailing Address - Street 2:RPTO MONTELLANO
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4118
Mailing Address - Country:US
Mailing Address - Phone:787-738-3876
Mailing Address - Fax:787-274-8477
Practice Address - Street 1:F35 CALLE B
Practice Address - Street 2:RPTO MONTELLANO
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4118
Practice Address - Country:US
Practice Address - Phone:787-738-3876
Practice Address - Fax:787-274-8477
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2149183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician