MEDICARE: LEMAR PONCE LLC

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
2	3336C0003X	Community/Retail Pharmacy	07F2287	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4024965	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1194767731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEMAR PONCE LLC

Provider Business Mailing Address
First Line	:	CALLE MUNOZ RIVERA ST 160
Second Line	:
City	:	GUAYANILLA
State	:	PR
Zip	:	00656
Country	:	US
Telephone Number	:	787-835-2370
Fax Number	:	787-835-2370

Provider Business Practice Location Address
First Line	:	CALLE MUNOZ RIVERA ST 160
Second Line	:
City	:	GUAYANILLA
State	:	PR
Zip	:	00656
Country	:	US
Telephone Number	:	787-835-2370
Fax Number	:	787-835-2370

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. IVONNE PONCE DE LEON
Credential	:
Telephone Number	:	178-744-8267

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	04/12/2023

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Directions to “LEMAR PONCE LLC ” Practice Location

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