Provider Demographics
NPI:1386907277
Name:BURGOS, MINERVA (RPH)
Entity type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAS CATALINAS MALL
Mailing Address - Street 2:ZAFIRO 52
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5200
Mailing Address - Country:US
Mailing Address - Phone:787-746-0020
Mailing Address - Fax:787-745-0578
Practice Address - Street 1:LAS CATALINAS MALL
Practice Address - Street 2:ZAFIRO 52
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5200
Practice Address - Country:US
Practice Address - Phone:787-746-0020
Practice Address - Fax:787-745-0578
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist