Provider Demographics
NPI:1053513291
Name:PAGAN, ELSIE LIDIA (RPH)
Entity type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:LIDIA
Last Name:PAGAN
Suffix:
Gender:F
Credentials:RPH
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 1077
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1077
Mailing Address - Country:US
Mailing Address - Phone:787-735-6533
Mailing Address - Fax:787-735-6533
Practice Address - Street 1:156 CALLE BALDORIOTY N
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3218
Practice Address - Country:US
Practice Address - Phone:787-735-4887
Practice Address - Fax:787-735-4887
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2722OtherLICENSE