Provider Demographics
NPI:1063870772
Name:COLON, JUANA ENID
Entity type:Individual
Prefix:DR
First Name:JUANA
Middle Name:ENID
Last Name:COLON
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:PO BOX 3242
Mailing Address - Street 2:URB VALLE DE ANDALUCIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-3124
Mailing Address - Country:US
Mailing Address - Phone:787-836-1123
Mailing Address - Fax:787-836-6546
Practice Address - Street 1:175 CARR PR 385
Practice Address - Street 2:WALGREENS 9118
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-836-1123
Practice Address - Fax:787-836-6546
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3871OtherPHARMACY LICENSE