Provider Demographics
NPI:1285912816
Name:JIMENEZ, NILSA I (RPH)
Entity type:Individual
Prefix:
First Name:NILSA
Middle Name:I
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RPH
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 625
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0625
Mailing Address - Country:US
Mailing Address - Phone:787-342-6535
Mailing Address - Fax:
Practice Address - Street 1:BO. VICTORIA CARR #2 KM 129
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-8044
Practice Address - Fax:787-882-0655
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist