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General NPI Number Information
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NPI Number | 1740329457
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Entity Type | Individual
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Provider Name | ILIANETTE MIRANDA R.PH.
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CARR. #2 KM 1.64 PLAZA MONSERRATE
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City | HORMIGUEROS
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State | PR
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Zip | 00660
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Country | US
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Telephone | 178-784-9074
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Fax | 178-784-9301
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Provider Business Mailing Address
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Address Line | 139 CALLE PEDRO D ACOSTA URB. SANTA MARIA
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City | SABANA GRANDE
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State | PR
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Zip | 00637-2079
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Country | US
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Telephone | 178-784-9074
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Fax | 178-784-9301
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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 | 4878
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License Number State | PR
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