Provider Demographics
NPI:1851675540
Name:GRATACOS, JOHANNA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:MARIE
Last Name:GRATACOS
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:HC 1 BOX 3284
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9710
Mailing Address - Country:US
Mailing Address - Phone:787-382-7705
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 3284
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-9710
Practice Address - Country:US
Practice Address - Phone:787-382-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist