Healthcare Provider Details

I. General information

NPI: 1417061441
Provider Name (Legal Business Name): MYRA JUAN PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO CAMPAMENTO 500 CARR 149 SUITE 01
CIALES PR
00638-9661
US

IV. Provider business mailing address

412 CALLE TULAIN ESTANCIAS DE TORTUGUERO
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-3105
  • Fax: 787-871-3122
Mailing address:
  • Phone: 787-858-7596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2126
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: