Provider Demographics
NPI:1043857766
Name:BERIGUETE MIRANDA, MADERIC J (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MADERIC
Middle Name:J
Last Name:BERIGUETE MIRANDA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-1310
Mailing Address - Country:US
Mailing Address - Phone:787-479-2862
Mailing Address - Fax:
Practice Address - Street 1:2550 AVE DE DIEGO
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4800
Practice Address - Country:US
Practice Address - Phone:787-762-8412
Practice Address - Fax:787-762-8479
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist