Provider Demographics
NPI:1124294335
Name:IGLESIAS, TAILYN (PHTECH)
Entity type:Individual
Prefix:
First Name:TAILYN
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:PHTECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC01 BOX 5401
Mailing Address - Street 2:SABANA HOYOS
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00688-0000
Mailing Address - Country:US
Mailing Address - Phone:787-880-4258
Mailing Address - Fax:787-816-5921
Practice Address - Street 1:CARRETERA 651 KM 2.5
Practice Address - Street 2:SECTOR EL HUNCO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-880-4258
Practice Address - Fax:787-816-5921
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5983183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician