Provider Demographics
NPI:1275092744
Name:MORENO QUILES, NYNOSHKA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NYNOSHKA
Middle Name:MARIE
Last Name:MORENO QUILES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVE LOS CHALETS APT 91
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4464
Mailing Address - Country:US
Mailing Address - Phone:787-374-1508
Mailing Address - Fax:
Practice Address - Street 1:150 CALLE F VIZCARRONDO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4483
Practice Address - Country:US
Practice Address - Phone:787-755-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist