Provider Demographics
NPI:1801621362
Name:CRUZ VILLANUEVA, KEVIN J (PHARM D)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:CRUZ VILLANUEVA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 J. RODRIGUEZ IRIZARRY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-879-4770
Mailing Address - Fax:
Practice Address - Street 1:AVE. CATALINA #104 SECTOR BARRANCA BO. HATO ABAJO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist