Healthcare Provider Details

I. General information

NPI: 1639463557
Provider Name (Legal Business Name): MIRIAM CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2 402
ANASCO PR
00610-0000
US

IV. Provider business mailing address

PO BOX 588
SAN SEBASTIAN PR
00685-0588
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-1093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4966
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: