Provider Demographics
NPI:1740440858
Name:OLIVERAS DIAZ, EDNA MILAGROS (RPH)
Entity type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:MILAGROS
Last Name:OLIVERAS DIAZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CALLE PRINCESA
Mailing Address - Street 2:EST DE LA FUENTE
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3608
Mailing Address - Country:US
Mailing Address - Phone:787-251-8650
Mailing Address - Fax:787-251-8650
Practice Address - Street 1:41 CALLE PRINCESA
Practice Address - Street 2:EST DE LA FUENTE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3608
Practice Address - Country:US
Practice Address - Phone:787-251-8650
Practice Address - Fax:787-251-8650
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist