Provider Demographics
NPI:1649306143
Name:LUGO PINA, JACQUELINE VANESSA
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:VANESSA
Last Name:LUGO PINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 REPARTO
Mailing Address - Street 2:ALTURAS DE PENUELAS 1
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624
Mailing Address - Country:US
Mailing Address - Phone:787-239-1275
Mailing Address - Fax:787-290-1907
Practice Address - Street 1:2046 REPARTO
Practice Address - Street 2:ALTURAS DE PENUELAS I
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-239-1275
Practice Address - Fax:787-290-1907
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003093183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR003093OtherAUXILIAR DE FARMACIA