Provider Demographics
NPI:1417061441
Name:JUAN, MYRA (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:JUAN
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CALLE TULAIN
Mailing Address - Street 2:ESTANCIAS DE TORTUGUERO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-858-7596
Mailing Address - Fax:
Practice Address - Street 1:BO CAMPAMENTO 500 CARR 149
Practice Address - Street 2:SUITE 01
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-9661
Practice Address - Country:US
Practice Address - Phone:787-871-3105
Practice Address - Fax:787-871-3122
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2126183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician