Provider Demographics
NPI:1467653410
Name:PINERO, MYRNA MILAGROS
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:MILAGROS
Last Name:PINERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 CALLE ONFALA
Mailing Address - Street 2:REPARTO APOLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5048
Mailing Address - Country:US
Mailing Address - Phone:787-789-6817
Mailing Address - Fax:
Practice Address - Street 1:BAXTER PHARMACY
Practice Address - Street 2:REPARTO BECHARA BUCHANAM
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-792-7550
Practice Address - Fax:787-792-4903
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2495OtherPHARMACIST LICENSE