Provider Demographics
NPI:1588268866
Name:ASPILCUETA ROJAS, JORGE HUMBERTO
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:HUMBERTO
Last Name:ASPILCUETA ROJAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DABBY WAY
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1270
Mailing Address - Country:US
Mailing Address - Phone:978-349-1470
Mailing Address - Fax:
Practice Address - Street 1:1815 MIDDLESEX ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1190
Practice Address - Country:US
Practice Address - Phone:978-458-4621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist