Basic Information
| Provider Information | |||||||||
| NPI: | 1407123151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARAGONES | ||||||||
| FirstName: | ELLIS | ||||||||
| MiddleName: | SHAMYR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMACIST | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ARAGONES | ||||||||
| OtherFirstName: | ELLIS | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PHARMACYST | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | CALLE TORCAZ URBANIZACION HACIENDA PALOMA | ||||||||
| Address2: | #81 | ||||||||
| City: | LUQUILLO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007730773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874359318 | ||||||||
| FaxNumber: | 7878601614 | ||||||||
| Practice Location | |||||||||
| Address1: | CALLE MARGINAL | ||||||||
| Address2: | 4203 | ||||||||
| City: | FAJARDO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007380738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878601603 | ||||||||
| FaxNumber: | 7878601614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2011 | ||||||||
| LastUpdateDate: | 11/23/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5147 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.