Provider Demographics
NPI:1770992646
Name:QUILES, EVELYN (9794)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:QUILES
Suffix:
Gender:F
Credentials:9794
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MW14 CALLE 411
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-1923
Mailing Address - Country:US
Mailing Address - Phone:787-762-5889
Mailing Address - Fax:787-752-0839
Practice Address - Street 1:SANCHEZ OSORIO AVENUE
Practice Address - Street 2:FARMACIA AMIGA VILLA FONTANA SHOPPING CENTER
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-762-5889
Practice Address - Fax:787-752-0839
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9794183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR165504OtherREGULATION AND CERTIFICATION