Provider Demographics
NPI:1093840456
Name:MIRANDA, LIDA ORIALIS (PHARMACYTECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:ORIALIS
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PHARMACYTECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE PASEO CLARO 401
Mailing Address - Street 2:URB VILLA PINARES
Mailing Address - City:VEGABAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-855-6609
Mailing Address - Fax:
Practice Address - Street 1:36 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-6530
Practice Address - Country:US
Practice Address - Phone:787-883-4140
Practice Address - Fax:787-270-3526
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6220183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician