MEDICARE: FARMACIA PLAZA ALTA INC

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	183500000X	Pharmacist	07-F-1975	PR

General Provider Information

NPI Number	:	1245335546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMACIA PLAZA ALTA INC

Provider Business Mailing Address
First Line	:	262 AVE SANTA ANA
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-3304
Country	:	US
Telephone Number	:	787-272-1205
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 AVE SANTA ANA
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-3304
Country	:	US
Telephone Number	:	787-272-1205
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEIDA ORTIZ
Credential	:
Telephone Number	:	787-272-1290

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/07/2023

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