Provider Demographics
NPI:1730259672
Name:TORRES, IVELISSE (RPH)
Entity type:Individual
Prefix:MRS
First Name:IVELISSE
Middle Name:
Last Name:TORRES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CALLE COPAMARINA
Mailing Address - Street 2:VILLAS DE LA PLAYA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-6025
Mailing Address - Country:US
Mailing Address - Phone:787-807-0923
Mailing Address - Fax:787-846-2334
Practice Address - Street 1:CARRETERA 2 KM 57
Practice Address - Street 2:CRUCE DAVILA
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-846-4583
Practice Address - Fax:787-846-2334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist