Healthcare Provider Details

I. General information

NPI: 1043460900
Provider Name (Legal Business Name): YEISMEL MIRANDA-VALDES PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD # 119
BRONX NY
10468-3904
US

IV. Provider business mailing address

549 ISHAM ST APT 58
NEW YORK NY
10034-2148
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax: 718-741-4406
Mailing address:
  • Phone: 787-598-1537
  • Fax: 718-741-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27727
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: