Provider Demographics
NPI:1699888339
Name:FARMACIA MIR MAR
Entity type:Organization
Organization Name:FARMACIA MIR MAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-864-1964
Mailing Address - Street 1:CECICILIA DOMIN GUEZ STREET # 1 EAST
Mailing Address - Street 2:P O BOX 2248
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-2248
Mailing Address - Country:US
Mailing Address - Phone:787-864-1964
Mailing Address - Fax:787-866-2278
Practice Address - Street 1:44 CALLE CALIMANO N
Practice Address - Street 2:BOX 2248
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-2248
Practice Address - Country:US
Practice Address - Phone:787-864-1962
Practice Address - Fax:787-866-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07F10503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR07F1050OtherSTATE LICENCE
PRDM 015453OtherSTATE LICENCE ASSMCA
PRDM 015453OtherSTATE LICENCE ASSMCA