Provider Demographics
NPI:1124435433
Name:OSORIO AMARO, MIGNELLY
Entity type:Individual
Prefix:
First Name:MIGNELLY
Middle Name:
Last Name:OSORIO AMARO
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:URB. MUNOZ RIVERA 1065 CALLE 17
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00969
Mailing Address - Country:UM
Mailing Address - Phone:787-527-1445
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE EL PARQUE
Practice Address - Street 2:BO. SANTA ROSA III
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-527-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10007183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician