Provider Demographics
NPI:1861746836
Name:DIAZ, MARIELY (RPH)
Entity type:Individual
Prefix:DR
First Name:MARIELY
Middle Name:
Last Name:DIAZ
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:HC 3 BOX 7525
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9539
Mailing Address - Country:US
Mailing Address - Phone:787-883-5957
Mailing Address - Fax:787-883-6040
Practice Address - Street 1:CARR 2 KM 26.2
Practice Address - Street 2:ESPINOSA WARD
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-883-5959
Practice Address - Fax:787-883-6040
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist