Healthcare Provider Details

I. General information

NPI: 1891836623
Provider Name (Legal Business Name): NIRO 2011 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. GENERAL VALERO # 305
FAJARDO PR
00738
US

IV. Provider business mailing address

AVE GENERAL VALERO #305
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-7788
  • Fax: 787-863-1422
Mailing address:
  • Phone: 787-863-7788
  • Fax: 787-863-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-0366
License Number StatePR

VIII. Authorized Official

Name: GIL NIEVES
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 787-403-0508