Provider Demographics
NPI:1053518688
Name:ARCHILLA, KEYLA M (PH T)
Entity type:Individual
Prefix:MISS
First Name:KEYLA
Middle Name:M
Last Name:ARCHILLA
Suffix:
Gender:F
Credentials:PH T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. LOS NARANJOS
Mailing Address - Street 2:CALLE 1 #72
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694
Mailing Address - Country:US
Mailing Address - Phone:787-858-9305
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION SAN FERNANDO
Practice Address - Street 2:CALL 6 B-35
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6289183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician