Provider Demographics
NPI:1952436420
Name:CONCEPCION, ERIC JAVIER (4090)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAVIER
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:4090
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE JOSE MARTI L-5
Mailing Address - Street 2:P.O. BOX 2172
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2172
Mailing Address - Country:US
Mailing Address - Phone:787-866-2088
Mailing Address - Fax:787-866-6051
Practice Address - Street 1:CALLE JOSE MARTI L-5
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785-2172
Practice Address - Country:US
Practice Address - Phone:787-866-2088
Practice Address - Fax:787-866-6051
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4090183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician