Provider Demographics
NPI:1982414082
Name:GONZALEZ DEL OLMO, EYDIE MARALYZ (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:MISS
First Name:EYDIE
Middle Name:MARALYZ
Last Name:GONZALEZ DEL OLMO
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
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 2868
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-8842
Mailing Address - Country:US
Mailing Address - Phone:787-462-1306
Mailing Address - Fax:
Practice Address - Street 1:9 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2712
Practice Address - Country:US
Practice Address - Phone:787-846-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011191183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR011191OtherPHARAMCY TECHNICIAN LICENSE
PR00200146OtherREGISTRO DE TECNICO DE FARMACIA