Provider Demographics
NPI:1730356767
Name:CRUZ, MARISOL (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
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:PO BOX 172
Mailing Address - Street 2:SECTOR CATANO
Mailing Address - City:CASTANER
Mailing Address - State:PR
Mailing Address - Zip Code:00631-0172
Mailing Address - Country:US
Mailing Address - Phone:787-816-5921
Mailing Address - Fax:787-816-5837
Practice Address - Street 1:CARR 651 KM 2.5 BO JUNCOS
Practice Address - Street 2:ARECIBO
Practice Address - City:ARECIBO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00612
Practice Address - Country:UM
Practice Address - Phone:787-816-5921
Practice Address - Fax:787-816-5837
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4583183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician