Provider Demographics
NPI:1689569923
Name:CLEMENTE SOTO, RAQUEL S
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:S
Last Name:CLEMENTE SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RAQUEL
Other - Middle Name:S
Other - Last Name:CLEMENTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACY TECHNICIAN
Mailing Address - Street 1:COSTCO PHARMACY #363 PARQUE INDUSTRIAL MINILLAS
Mailing Address - Street 2:#125 CALLE A
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-993-9310
Mailing Address - Fax:787-993-9307
Practice Address - Street 1:COSTCO PHARMACY #363 PARQUE INDUSTRIAL MINILLAS
Practice Address - Street 2:#125 CALLE A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-993-9310
Practice Address - Fax:787-993-9307
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006346183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician