Provider Demographics
NPI:1053525832
Name:DIAZ, JOSE A (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VEREDAS
Mailing Address - Street 2:#68 DE LOS FLAMBOYANES
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-286-3593
Mailing Address - Fax:787-286-3593
Practice Address - Street 1:URB VEREDAS
Practice Address - Street 2:#68 DE LOS FLAMBOYANES
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-286-3593
Practice Address - Fax:787-286-3593
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist