Provider Demographics
NPI:1386283604
Name:CACERES, GUSTAVO (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:CACERES
Suffix:
Gender:M
Credentials:PHARMACIST
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 399
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0399
Mailing Address - Country:US
Mailing Address - Phone:787-832-2432
Mailing Address - Fax:787-805-6920
Practice Address - Street 1:CALLE RAMON EMETERIO BETANCES
Practice Address - Street 2:50 N
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-2432
Practice Address - Fax:787-805-6920
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist