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NPI Code Detail

MEDICARE: DLR CONDADO PHARMACY

MEDICARE: DLR CONDADO PHARMACY
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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy15F2783PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12127984OTHERPK

General Provider Information

NPI Number : 1073816427
Entity Type Code : Organization
Provider Name (Legal Business Name) : DLR CONDADO PHARMACY
Provider Business Mailing Address
First Line : PO BOX 195417
Second Line :
City : SAN JUAN
State : PR
Zip : 00919-5417
Country : US
Telephone Number : 787-758-0168
Fax Number : 787-753-5906
Provider Business Practice Location Address
First Line : 186 CALLE JUAN P DUARTE
Second Line : HATO REY
City : SAN JUAN
State : PR
Zip : 00917-3602
Country : US
Telephone Number : 787-758-0168
Fax Number : 787-753-5906
Authorized Official
Title or Position : TREASURER
Name : MANUEL DE LEON
Credential :
Telephone Number : 787-758-0138
Provider Enumeration Date : 12/07/2010
Last Update Date : 05/22/2014

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Directions to “DLR CONDADO PHARMACY ” Practice Location

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