Provider Demographics
NPI:1306977236
Name:MILORL LLC
Entity type:Organization
Organization Name:MILORL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-786-1084
Mailing Address - Street 1:AVE SANTA ROSA SUITE 17
Mailing Address - Street 2:LA CUMBRE SHOPPING CENTER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-720-8854
Mailing Address - Fax:787-287-4975
Practice Address - Street 1:AVE. SANTA ROSA SUITE 17
Practice Address - Street 2:LA CUMBRE SHOPPING CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5402
Practice Address - Country:US
Practice Address - Phone:787-720-8854
Practice Address - Fax:787-287-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
PR19-F31223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039805100Medicaid