Provider Demographics
NPI:1487326153
Name:ROSA, JOHANA (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:JOHANA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 AVE. F. D. ROOSEVELT, SUITE 19
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2732
Mailing Address - Country:US
Mailing Address - Phone:787-783-4510
Mailing Address - Fax:787-792-0831
Practice Address - Street 1:1484 AVE F D ROOSEVELT
Practice Address - Street 2:SUITE 19
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2732
Practice Address - Country:US
Practice Address - Phone:787-783-4510
Practice Address - Fax:787-792-0831
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14734183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660263057Other1184722019