Provider Demographics
NPI:1124161351
Name:LEON, EVETTE RENE
Entity type:Individual
Prefix:MRS
First Name:EVETTE
Middle Name:RENE
Last Name:LEON
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:HC 02 BOX 12814
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9614
Mailing Address - Country:US
Mailing Address - Phone:787-746-0379
Mailing Address - Fax:
Practice Address - Street 1:FARMACIA RUIZ BELVIS RAFAEL CORDERO 17
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-4919
Practice Address - Fax:787-703-1725
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4181183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician