Provider Demographics
NPI:1154809143
Name:BABILONIA, DEMARIS ANGELIQUE
Entity type:Individual
Prefix:MRS
First Name:DEMARIS
Middle Name:ANGELIQUE
Last Name:BABILONIA
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 421
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0421
Mailing Address - Country:US
Mailing Address - Phone:787-512-9284
Mailing Address - Fax:
Practice Address - Street 1:CARR 110 KM 10.7 INT BO CRUZ
Practice Address - Street 2:SECT ISLETA
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0067
Practice Address - Country:US
Practice Address - Phone:787-512-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012118183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician