Provider Demographics
NPI:1457446601
Name:MIRANDA, JORGE R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:R
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CALLE URUGUAY
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2009
Mailing Address - Country:US
Mailing Address - Phone:787-646-0720
Mailing Address - Fax:787-756-8872
Practice Address - Street 1:207 CALLE URUGUAY
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-2009
Practice Address - Country:US
Practice Address - Phone:787-646-0720
Practice Address - Fax:787-756-8872
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist