Provider Demographics
NPI:1306059969
Name:CABELLO, WANDA I (PHARMACY TECH)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:I
Last Name:CABELLO
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P40 CALLE 12
Mailing Address - Street 2:VILLAS DE SAN AGUSTIN II
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-2032
Mailing Address - Country:US
Mailing Address - Phone:787-613-8558
Mailing Address - Fax:787-790-3925
Practice Address - Street 1:P40 CALLE 12
Practice Address - Street 2:VILLAS DE SAN AGUSTIN II
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-2032
Practice Address - Country:US
Practice Address - Phone:787-613-8558
Practice Address - Fax:787-790-3925
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4059183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician