1093840456 NPI number — MRS. LIDA ORIALIS MIRANDA PHARMACYTECHNICIAN

Table of content: MRS. LIDA ORIALIS MIRANDA PHARMACYTECHNICIAN (NPI 1093840456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093840456 NPI number — MRS. LIDA ORIALIS MIRANDA PHARMACYTECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRANDA
Provider First Name:
LIDA
Provider Middle Name:
ORIALIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACYTECHNICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093840456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE PASEO CLARO 401
Provider Second Line Business Mailing Address:
URB VILLA PINARES
Provider Business Mailing Address City Name:
VEGABAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-855-6609
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 CALLE MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VEGA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00692-6530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-883-4140
Provider Business Practice Location Address Fax Number:
787-270-3526
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  6220 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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