Provider Demographics
NPI:1104958354
Name:COLON, LYDIA ROSA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ROSA
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:C39 CALLE MADRE PERLA
Mailing Address - Street 2:DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2128
Mailing Address - Country:US
Mailing Address - Phone:787-725-2737
Mailing Address - Fax:787-725-1667
Practice Address - Street 1:C39 CALLE MADRE PERLA
Practice Address - Street 2:DORADO DEL MAR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2128
Practice Address - Country:US
Practice Address - Phone:787-725-2737
Practice Address - Fax:787-725-1667
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist