Provider Demographics
NPI:1992907422
Name:CERVONI, WILMARIE (CPHT)
Entity type:Individual
Prefix:MRS
First Name:WILMARIE
Middle Name:
Last Name:CERVONI
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560615
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-0615
Mailing Address - Country:US
Mailing Address - Phone:787-415-1668
Mailing Address - Fax:787-835-6681
Practice Address - Street 1:963 MUNOZ RIVERA ST.
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-836-2173
Practice Address - Fax:787-836-6102
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5937183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5937OtherCPHT