Provider Demographics
NPI:1811364730
Name:PACHECO, JANICE
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:PACHECO
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:PMB 177 PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:MERCEDITAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00715
Mailing Address - Country:PK
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 CARR 14
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2163
Practice Address - Country:US
Practice Address - Phone:787-651-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9070183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician