Provider Demographics
NPI:1407997984
Name:MIAA INC
Entity Type:Organization
Organization Name:MIAA INC
Other - Org Name:FARMACIA YARY AM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON CHINEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-851-8200
Mailing Address - Street 1:44 CALLE SALVADOR BRAU
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3413
Mailing Address - Country:US
Mailing Address - Phone:787-851-1275
Mailing Address - Fax:787-851-0667
Practice Address - Street 1:44 CALLE SALVADOR BRAU
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3413
Practice Address - Country:US
Practice Address - Phone:787-851-1275
Practice Address - Fax:787-851-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17F3000333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134181OtherPK