Provider Demographics
NPI:1598805475
Name:MISES ABREU CORDERO
Entity Type:Organization
Organization Name:MISES ABREU CORDERO
Other - Org Name:FARMACIA LOS MAESTROS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-8811
Mailing Address - Street 1:AVE MUNIZ SOUFFRONT
Mailing Address - Street 2:STE 459
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-765-8811
Mailing Address - Fax:787-282-6845
Practice Address - Street 1:CALLE MUNIZ SOUFFRONT
Practice Address - Street 2:STE 459
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-765-8811
Practice Address - Fax:787-282-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR15F11173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084987OtherPK