Basic Information
| Provider Information | |||||||||
| NPI: | 1053513291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAGAN | ||||||||
| FirstName: | ELSIE | ||||||||
| MiddleName: | LIDIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1077 | ||||||||
| Address2: | |||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007051077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877356533 | ||||||||
| FaxNumber: | 7877356533 | ||||||||
| Practice Location | |||||||||
| Address1: | 156 CALLE BALDORIOTY N | ||||||||
| Address2: | |||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007053218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877354887 | ||||||||
| FaxNumber: | 7877354887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2722 | PR | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 2722 | 01 | PR | LICENSE | OTHER |