Provider Demographics
NPI:1083951966
Name:MIAA INC
Entity Type:Organization
Organization Name:MIAA INC
Other - Org Name:FARMACIA LA 100
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RPH/I/C
Authorized Official - Prefix:
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-910-7910
Mailing Address - Street 1:CALLE BRAU # 44
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 100 KM 5.8
Practice Address - Street 2:BO. MIRADERO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:939-910-7910
Practice Address - Fax:939-910-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR14F30773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4028379OtherNCPDP PROVIDER IDENTIFICATION NUMBER