Provider Demographics
NPI:1902199987
Name:DIAZ, MILDRED DE LOURDES (REGISTER PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:DE LOURDES
Last Name:DIAZ
Suffix:
Gender:F
Credentials:REGISTER PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5984 AVE ISLA VERDE # PR00979
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-5776
Mailing Address - Country:US
Mailing Address - Phone:787-982-0390
Mailing Address - Fax:787-982-0570
Practice Address - Street 1:5984 AVE ISLA VERDE
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-5776
Practice Address - Country:US
Practice Address - Phone:787-982-0390
Practice Address - Fax:787-982-0570
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist