Healthcare Provider Details

I. General information

NPI: 1568646685
Provider Name (Legal Business Name): MRS. MYRNA AQUINO DAOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BOSTON RD C/O RITE AID PHARMACY #1665
BRONX NY
10469-4127
US

IV. Provider business mailing address

2750 BOSTON RD C/O RITE AID PHARMACY #1665
BRONX NY
10469-4127
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-2127
  • Fax:
Mailing address:
  • Phone: 718-405-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: