Provider Demographics
NPI:1821829185
Name:GOYCO FERGELEC, PAOLA MICHELLE
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:MICHELLE
Last Name:GOYCO FERGELEC
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 1:11 AVE 1
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-5632
Mailing Address - Country:US
Mailing Address - Phone:787-233-9458
Mailing Address - Fax:
Practice Address - Street 1:2 CARR 140
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2261
Practice Address - Country:US
Practice Address - Phone:787-846-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist