Provider Demographics
NPI:1356562722
Name:AYALA, EFRAIN (RPH)
Entity type:Individual
Prefix:MR
First Name:EFRAIN
Middle Name:
Last Name:AYALA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0825
Mailing Address - Country:US
Mailing Address - Phone:787-852-9234
Mailing Address - Fax:787-852-2602
Practice Address - Street 1:12 CALLE NOYA HERNANDEZ E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4175
Practice Address - Country:US
Practice Address - Phone:787-852-9234
Practice Address - Fax:787-852-2602
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist