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General NPI Number Information
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NPI Number | 1699073833
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Entity Type | Individual
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Provider Name | MRS. BRIGIDA MIMOSA JURADO
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Gender | Female
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Dates
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Enumeration Date | 03/12/2011
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Last Update Date | 03/12/2011
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Provider Practice Location Address
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Address Line | 6798 SHALLOWFORD RD
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City | LEWISVILLE
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State | NC
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Zip | 27023-9724
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Country | US
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Telephone | 336-945-2106
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Fax |
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Provider Business Mailing Address
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Address Line | 4535 PEBBLE LAKE DR
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City | PFAFFTOWN
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State | NC
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Zip | 27040-9241
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Country | US
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Telephone | 336-414-2640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18550
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License Number State | NC
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