Provider Demographics
NPI:1477012888
Name:ADORNO, OLGA IRIS (RPH)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:IRIS
Last Name:ADORNO
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:K 24 CALLE 1
Mailing Address - Street 2:URB VALPARAISO
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-248-8356
Mailing Address - Fax:
Practice Address - Street 1:K 24 CALLE 1
Practice Address - Street 2:URB VALPARAISO
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-248-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12142747OtherUS PASSPORT CARD
PR01398218OtherLICENSE