Provider Demographics
NPI:1154951846
Name:COLON-ROSA, ROBERTO ANDRES
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANDRES
Last Name:COLON-ROSA
Suffix:
Gender:M
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 2695
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2695
Mailing Address - Country:US
Mailing Address - Phone:787-212-8863
Mailing Address - Fax:
Practice Address - Street 1:60 AVE LOS DOMINICOS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4724
Practice Address - Country:US
Practice Address - Phone:787-795-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist