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General NPI Number Information
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NPI Number | 1083863997
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Entity Type | Organization
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Legal Business Name | MILDRED, INC.
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | COND EMILIANO POL # 489
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City | SAN JUAN
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State | PR
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Zip | 00917-5102
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Country | US
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Telephone | 787-702-1300
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Fax | 787-708-1800
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Provider Business Mailing Address
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Address Line | 749 CALLE LINCOLN
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City | SAN JUAN
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State | PR
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Zip | 00926-5627
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Country | US
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Telephone | 787-708-1300
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Fax | 787-708-1800
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Authorized Official
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Title or Position | PHARMACIST
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Name | MILDRED QUINTANA
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Credential |
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Telephone | 787-708-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10-F-2651
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License Number State | PR
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