MEDICARE: MRS. MAYRA E BORRERO BD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	4461	PR

General Provider Information

NPI Number	:	1114050747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAYRA E BORRERO BD

Provider Business Mailing Address
First Line	:	PO BOX 532
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0532
Country	:	US
Telephone Number	:	787-876-4863
Fax Number	:

Provider Business Practice Location Address
First Line	:	LOIZA VALLEY MALL
Second Line	:	SUITE AA-12
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0000
Country	:	US
Telephone Number	:	787-876-3400
Fax Number	:	787-876-7631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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