Basic Information
| Provider Information | |||||||||
| NPI: | 1205388972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSQUETS | ||||||||
| FirstName: | IRAIDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PR2 KM 2.2 | ||||||||
| Address2: | KENNEDY DRIVE | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875223601 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | PR2 KM 2.2 | ||||||||
| Address2: | AVE MARGINAL JOHN F KENNEDY | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875223601 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2016 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03625 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.