Provider Demographics
NPI:1801436084
Name:ALDARONDO, IVELLISSE (PHARMD)
Entity type:Individual
Prefix:
First Name:IVELLISSE
Middle Name:
Last Name:ALDARONDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 AVE MILITAR
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4060
Mailing Address - Country:US
Mailing Address - Phone:787-830-3189
Mailing Address - Fax:787-830-1573
Practice Address - Street 1:2916 AVE MILITAR
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4060
Practice Address - Country:US
Practice Address - Phone:787-830-3189
Practice Address - Fax:787-830-1573
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR126128OtherCERTIFICATE OF REGISTRATION