Basic Information
Provider Information
NPI: 1528189313
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADORNO
FirstName: JOSE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
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OtherLastName:  
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OtherCredential:  
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Mailing Information
Address1: CALLE 2 F 22 BONEVILLE TERRACE
Address2:  
City: CAGUAS
State: PR
PostalCode: 00725
CountryCode: US
TelephoneNumber: 7877465648
FaxNumber: 7877773545
Practice Location
Address1: FARMACIA CENTRO MEDICO, BO. MONACILLOS
Address2:  
City: RIO PIEDRAS
State: PR
PostalCode: 009262129
CountryCode: US
TelephoneNumber: 7877773535
FaxNumber: 7877773545
Other Information
ProviderEnumerationDate: 04/02/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X3265PRY Pharmacy Service ProvidersPharmacist 

No ID Information.


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