Provider Demographics
NPI:1528109600
Name:BERRIOS, NOEMI (PH)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 71 BOX 3011
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9739
Mailing Address - Country:US
Mailing Address - Phone:787-869-2506
Mailing Address - Fax:787-869-7545
Practice Address - Street 1:FARMACIA COOPERATIVA SAN MIGUEL
Practice Address - Street 2:152 STREET KM 17.8
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0459
Practice Address - Country:US
Practice Address - Phone:787-869-4710
Practice Address - Fax:787-869-1416
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist