Provider Demographics
NPI:1104112820
Name:SOTOMAYOR, AUREA V (RPH)
Entity type:Individual
Prefix:
First Name:AUREA
Middle Name:V
Last Name:SOTOMAYOR
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:PO BOX 3334
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-3334
Mailing Address - Country:US
Mailing Address - Phone:787-862-0104
Mailing Address - Fax:787-862-0405
Practice Address - Street 1:200 CARR 137
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3025
Practice Address - Country:US
Practice Address - Phone:787-862-0104
Practice Address - Fax:787-862-0405
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist