Provider Demographics
NPI:1033768189
Name:REYES ALICEA, LYANNE J (PHARMD)
Entity type:Individual
Prefix:
First Name:LYANNE
Middle Name:J
Last Name:REYES ALICEA
Suffix:
Gender:F
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:A25 PEDRO P. COLON STREET
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-585-8848
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL MENONITA CAGUAS
Practice Address - Street 2:URB. TURABO GARDENS CARR. 172 CAGUAS A CIDRA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-653-0550
Practice Address - Fax:787-653-0538
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty