Provider Demographics
NPI:1083863997
Name:MILDRED, INC.
Entity Type:Organization
Organization Name:MILDRED, INC.
Other - Org Name:FARMACIA VILLA ESPERANZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-708-1300
Mailing Address - Street 1:749 CALLE LINCOLN
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5627
Mailing Address - Country:US
Mailing Address - Phone:787-708-1300
Mailing Address - Fax:787-708-1800
Practice Address - Street 1:COND EMILIANO POL # 489
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5102
Practice Address - Country:US
Practice Address - Phone:787-702-1300
Practice Address - Fax:787-708-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10-F-26513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy