Provider Demographics
NPI:1992231344
Name:HICIANO, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HICIANO
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:CALLLE ESPER
Mailing Address - Street 2:23
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLLE ESPER
Practice Address - Street 2:23
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00956-4766
Practice Address - Country:US
Practice Address - Phone:939-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1234OtherNOT APPLY