Provider Demographics
NPI:1164864492
Name:BONILLA, LUZ MIGDALIA (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MIGDALIA
Last Name:BONILLA
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION PROMISED LAND CASA 66
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718
Mailing Address - Country:US
Mailing Address - Phone:787-362-5704
Mailing Address - Fax:787-874-4796
Practice Address - Street 1:URBANIZACION PROMISED LAND CASA 66
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-362-5704
Practice Address - Fax:787-874-4796
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2683183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician