Provider Demographics
NPI:1699429662
Name:JIMENEZ SANCHEZ, EDWIN GABRIEL (PHARMD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:GABRIEL
Last Name:JIMENEZ SANCHEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 66729
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-8806
Mailing Address - Country:US
Mailing Address - Phone:787-631-0570
Mailing Address - Fax:
Practice Address - Street 1:2097 AVE HOSTOS DF 01552 9
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-805-4805
Practice Address - Fax:787-805-4010
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist