Provider Demographics
NPI:1891522769
Name:VIERA, GRACE PENA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:PENA
Last Name:VIERA
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:HC 1 BOX 4200
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-9776
Mailing Address - Country:US
Mailing Address - Phone:787-384-8029
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 4200
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-9776
Practice Address - Country:US
Practice Address - Phone:787-384-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8624183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician