Provider Demographics
NPI:1053951889
Name:CARDONA, JULISSA (RPH)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:
Last Name:CARDONA
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:HC 57 BOX 10675
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9849
Mailing Address - Country:US
Mailing Address - Phone:787-910-9259
Mailing Address - Fax:
Practice Address - Street 1:162 CALLE MARINA
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3213
Practice Address - Country:US
Practice Address - Phone:787-868-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist