Provider Demographics
NPI:1447587266
Name:COSME, LUZ MINERVA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MINERVA
Last Name:COSME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 CALLE NAPOLES
Mailing Address - Street 2:URB. VILLA CAPRI
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:586 CALLE NAPOLES
Practice Address - Street 2:URB. VILLA CAPRI
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4604
Practice Address - Country:US
Practice Address - Phone:787-755-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist