Provider Demographics
NPI:1588957450
Name:BALLESTER, VANESSA ILEANA (RPH)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:ILEANA
Last Name:BALLESTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L-5 CANADA ST
Mailing Address - Street 2:ALTURAS DEL REMANSO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6134
Mailing Address - Country:US
Mailing Address - Phone:787-948-7226
Mailing Address - Fax:787-771-1649
Practice Address - Street 1:L-5 CANADA ST
Practice Address - Street 2:ALTURAS DEL REMANSO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6134
Practice Address - Country:US
Practice Address - Phone:787-948-7226
Practice Address - Fax:787-771-1649
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist