Provider Demographics
NPI:1972888964
Name:CLAUDIO, ENRIQUE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:CLAUDIO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MEMORIAL DRIVE
Mailing Address - Street 2:QUINTAS DEL BULEVAR
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4400
Mailing Address - Country:US
Mailing Address - Phone:787-269-7808
Mailing Address - Fax:787-774-0555
Practice Address - Street 1:5 MEMORIAL DRIVE
Practice Address - Street 2:QUINTAS DEL BULEVAR
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4400
Practice Address - Country:US
Practice Address - Phone:787-269-7808
Practice Address - Fax:787-774-0555
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3182OtherPHARMACIST LIC