Provider Demographics
NPI:1467030205
Name:SUAREZ, NICOLE Y
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:Y
Last Name:SUAREZ
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 5986
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5986
Mailing Address - Country:US
Mailing Address - Phone:787-746-5952
Mailing Address - Fax:787-744-3397
Practice Address - Street 1:VILLA DEL REY 3RA SECC
Practice Address - Street 2:CARR 172 ESQ ASTURIAS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-5952
Practice Address - Fax:787-744-3397
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13101183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician