Provider Demographics
NPI:1487786778
Name:SOTO, PEDRO LUIS (BS PH)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:LUIS
Last Name:SOTO
Suffix:
Gender:M
Credentials:BS PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.VILLA SERAL A53
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-3010
Mailing Address - Country:US
Mailing Address - Phone:787-897-6336
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE RAMON DE JESUS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2204
Practice Address - Country:US
Practice Address - Phone:787-897-2464
Practice Address - Fax:787-897-3231
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR486034OtherDRIVER LICENCE