Provider Demographics
NPI:1063051423
Name:IRIZARRY, JOSE RAMON
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:
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 385
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0385
Mailing Address - Country:US
Mailing Address - Phone:787-897-2900
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE RAMIREZ
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2428
Practice Address - Country:US
Practice Address - Phone:787-897-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty