Provider Demographics
NPI:1760753800
Name:MIGUEL, LILLIANA
Entity Type:Individual
Prefix:MS
First Name:LILLIANA
Middle Name:
Last Name:MIGUEL
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 1:323 VIA DE LA MONTANA
Mailing Address - Street 2:VALLE SAN LUIS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3374
Mailing Address - Country:US
Mailing Address - Phone:787-420-9027
Mailing Address - Fax:
Practice Address - Street 1:323 VIA DE LA MONTANA
Practice Address - Street 2:VALLE SAN LUIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3374
Practice Address - Country:US
Practice Address - Phone:787-420-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3873OtherPHARMACIST