Basic Information
| Provider Information | |||||||||
| NPI: | 1881123669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIMENEZ QUINONES | ||||||||
| FirstName: | EDDA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | A84 URB SAN MIGUEL | ||||||||
| Address2: | |||||||||
| City: | SANTA ISABEL | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007572513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873587097 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7814 N DALE MABRY HWY | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336143220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133975300 | ||||||||
| FaxNumber: | 8134053942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6263 | PR | N | Pharmacy Service Providers | Pharmacist | 183500000X | PS54793 | FL | N | Pharmacy Service Providers | Pharmacist | 1835G0303X | 6263 | PR | Y | Pharmacy Service Providers | Pharmacist | Geriatric |
No ID Information.