MEDICARE: PROFESSIONAL DRUG 1

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	15-F-0813	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4019724	OTHER	PR	NCPDP

General Provider Information

NPI Number	:	1033246806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL DRUG 1

Provider Business Mailing Address
First Line	:	PO BOX 51666
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00950-1666
Country	:	US
Telephone Number	:	787-870-0978
Fax Number	:

Provider Business Practice Location Address
First Line	:	B35 CALLE 6
Second Line	:	URB SANFERNANDO
City	:	TOA ALTA
State	:	PR
Zip	:	00953-2205
Country	:	US
Telephone Number	:	787-870-2935
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NILZA IRIS SANTIAGO
Credential	:	PHARMACIST
Telephone Number	:	787-870-2935

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	05/06/2014

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Directions to “PROFESSIONAL DRUG 1 ” Practice Location

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