Provider Demographics
NPI:1699894790
Name:LABOY, EDWIN ANTONIO (PHARMACY TECH)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:ANTONIO
Last Name:LABOY
Suffix:
Gender:M
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 4730
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9656
Mailing Address - Country:US
Mailing Address - Phone:787-247-7274
Mailing Address - Fax:
Practice Address - Street 1:266 AVE LAURO PINERO
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2706
Practice Address - Country:US
Practice Address - Phone:787-885-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4652183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician