Provider Demographics
NPI:1366572786
Name:LUGO, AIDA (PH)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0959
Mailing Address - Country:US
Mailing Address - Phone:787-804-0225
Mailing Address - Fax:787-804-0225
Practice Address - Street 1:STREET SAN ISIDRO
Practice Address - Street 2:#26
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-804-0225
Practice Address - Fax:787-804-0225
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist