Provider Demographics
NPI:1538766118
Name:AGOSTO, JOSE GILBERTO (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:GILBERTO
Last Name:AGOSTO
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 PALACIOS DEL RIO 2
Mailing Address - Street 2:835 CALLE ROSARIO G12
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:939-207-2225
Mailing Address - Fax:
Practice Address - Street 1:1507 CALLE AUGUSTO RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-705-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3672183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician