Provider Demographics
NPI:1871341396
Name:CAMPOS CORDERO, DALIANA MILAGROS (PHARMD)
Entity type:Individual
Prefix:
First Name:DALIANA
Middle Name:MILAGROS
Last Name:CAMPOS CORDERO
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:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0016
Mailing Address - Country:US
Mailing Address - Phone:787-381-8990
Mailing Address - Fax:
Practice Address - Street 1:COTO SUR CARRETERA 670 KM 1.0
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist