Provider Demographics
NPI:1821813767
Name:OLMEDA, GERALDO RAFAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:GERALDO
Middle Name:RAFAEL
Last Name:OLMEDA
Suffix:
Gender:M
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:URB. VILLAS DEL SOL
Mailing Address - Street 2:CALLE 1 F3
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:954-868-2624
Mailing Address - Fax:
Practice Address - Street 1:282 AVE JESUS T PINERO UNIT 100
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-3921
Practice Address - Country:US
Practice Address - Phone:787-523-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist