Provider Demographics
NPI:1245524842
Name:MALDONADO, MITSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MITSA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 EL SENORIAL AVENIDA WINSTON CHURCHILL
Mailing Address - Street 2:WALGREENS 12649
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:787-751-7219
Mailing Address - Fax:787-751-7246
Practice Address - Street 1:158 EL SENORIAL AVENIDA WINSTON CHURCHILL
Practice Address - Street 2:WALGREENS 12649
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-751-7219
Practice Address - Fax:787-751-7246
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist