Provider Demographics
NPI:1881941797
Name:CONDE-JIMENEZ, JEAN MARIE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:CONDE-JIMENEZ
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:RR 7 BOX 17060
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-8838
Mailing Address - Country:US
Mailing Address - Phone:787-396-6921
Mailing Address - Fax:787-780-8486
Practice Address - Street 1:CARR PR 2, PR 866
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-780-8426
Practice Address - Fax:787-780-8486
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist