Provider Demographics
NPI:1568646685
Name:DAOS, MYRNA AQUINO
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:AQUINO
Last Name:DAOS
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 1:2750 BOSTON RD
Mailing Address - Street 2:C/O RITE AID PHARMACY #1665
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4127
Mailing Address - Country:US
Mailing Address - Phone:718-405-2127
Mailing Address - Fax:
Practice Address - Street 1:2750 BOSTON RD
Practice Address - Street 2:C/O RITE AID PHARMACY #1665
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4127
Practice Address - Country:US
Practice Address - Phone:718-405-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00913759Medicaid