Provider Demographics
NPI:1831210947
Name:CASIANO, WANDA NOEMI
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:NOEMI
Last Name:CASIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 8#172 LA PARGUERA
Mailing Address - Street 2:HC-01 BOX 4710
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-9704
Mailing Address - Country:US
Mailing Address - Phone:787-538-4811
Mailing Address - Fax:
Practice Address - Street 1:FARMACIA HOSPITAL METROPOLITANO
Practice Address - Street 2:CALLE JAVILLA #63
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician