Provider Demographics
NPI:1043460900
Name:MIRANDA-VALDES, YEISMEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:YEISMEL
Middle Name:
Last Name:MIRANDA-VALDES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 ISHAM ST APT 58
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2148
Mailing Address - Country:US
Mailing Address - Phone:787-598-1537
Mailing Address - Fax:718-741-4406
Practice Address - Street 1:130 W KINGSBRIDGE RD # 119
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:718-741-4406
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist