Provider Demographics
NPI:1447504873
Name:NIEVES, VICTOR (PHARMD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:NIEVES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TERRAZAS DE GUAYNABO, ALHELI N-21
Mailing Address - Street 2:GUAYNABO, PR 00969
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5423
Mailing Address - Country:US
Mailing Address - Phone:787-767-1636
Mailing Address - Fax:787-767-1122
Practice Address - Street 1:WALGREENS CO.
Practice Address - Street 2:65 DE INFANTERIA SHOPPING CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-767-1636
Practice Address - Fax:787-767-1122
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist